WorldWideScience

Sample records for clinical remission lead

  1. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important?

    DEFF Research Database (Denmark)

    Linde, Louise; Sørensen, Jan; Østergaard, Mikkel

    2010-01-01

    To compare health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) to that of the general population and to investigate the association with disease activity, focusing on different clinical remission criteria.......To compare health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) to that of the general population and to investigate the association with disease activity, focusing on different clinical remission criteria....

  2. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important?

    DEFF Research Database (Denmark)

    Linde, Louise; Sørensen, Jan; Østergaard, Mikkel

    2010-01-01

    OBJECTIVE: To compare health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) to that of the general population and to investigate the association with disease activity, focusing on different clinical remission criteria. METHODS: EQ-5D data from 3156 patients with RA from...... 11 Danish centers were compared with Danish EQ-5D population norms (n = 16,136). The Disease Activity Score (DAS28) and the Clinical Disease Activity Index score (CDAI) were used as definitions of disease activity and clinical remission. The score difference (DeltaEQ-5D) was calculated in each...

  3. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations.

    Science.gov (United States)

    Ajeganova, Sofia; Huizinga, Tom

    2017-10-01

    Sustained remission is an ultimate treatment goal in the management of patients with rheumatoid arthritis (RA). Historically the frequency of sustained remission was low but the frequency of achieved sustained remission is increasing over time. The last years' clinical studies of tight control targeted treatment and intervention trials of early use of intensive strategy suggest that these treatment strategies are associated with higher rates of sustained remission. Achievement of sustained remission, in particular but not limited to early sustained remission, can provide tapering and stopping disease-modifying antirheumatic drugs (DMARDs). With new treatment strategies drug-free sustained remission is becoming an achievable goal. Sustained remission is associated with improved outcomes in regard to function, patient-reported outcomes and survival. Drug-free sustained remission is characterized by normalized function ability and survival. Sustained remission and, in particular, drug-free sustained remission offer hope that early identification of patients with arthritis, early improved novel treatments and treatment with target to achieve remission may potentially transform the progressive course of RA disease and disrupt RA chronicity. In this review we summarize the recent evidence on sustained remission in patients with RA, treatment strategies to achieve sustained remission, management of patients in sustained remission and significance of sustained remission from the patient perspective.

  4. Remission of Rheumatoid Arthritis in Clinical Practice: Application of the ACR/EULAR 2011 Remission Criteria

    Science.gov (United States)

    Shahouri, Shadi H.; Michaud, Kaleb; Mikuls, Ted R.; Caplan, Liron; Shaver, Timothy S.; Anderson, James D.; Weidensaul, David N.; Busch, Ruth E.; Wang, Shirley; Wolfe, Frederick

    2011-01-01

    Purpose To describe use of the ACR/EULAR (AE) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods We examined remission in the US Veterans Affairs RA (VARA) registry of 1,341 patients (91% men) with 9,700 visits and a community rheumatology practice (ARCK) of 1,168 patients (28% men) with 6,362 visits. We studied cross-sectional and cumulative probabilities, agreement among various remission criteria, and aspects of reliability using Boolean definitions and CDAI and SDAI methods proposed by AE. Results By AE definition for community practice (swollen and tender joints ≤1, patient global ≤1), cross-sectional remission was 7.5% (6.4, 8.7) for ARCK and 8.9% (7.9, 9.9) for VARA. Cumulative or remission at any observation was 18.0% (ARCK) and 24.4% (VARA) over a mean of 2.2 years. Addition of ESR or CRP to criteria reduced remission to 5.0-6.2%, and use of CDAI/SDAI increased proportions to 6.9-10.1%. 1.8%-4.6% of patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good by Kappa and Jaccard measures. Among patients in remission, the probability of a remission lasting 2 years was 6.0%-14.1%. Among all patients the probability of a remission lasting 2 years was <3%. Remission and examination results varied substantially among physicians by multilevel analyses. Conclusion Cross-sectional remission occurs at 5.0%-10.1%, with cumulative remission 2-3 times greater. Long-term remissions are rare. Problems with reliability and agreement limit criteria usefulness in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community. PMID:21739423

  5. Dyspnoea perception during clinical remission of atopic asthma

    NARCIS (Netherlands)

    L.M. van den Toorn (Leon); S.E. Overbeek (Shelley); J-B. Prins (Jan-Bas); H.C. Hoogsteden (Henk); J.C. de Jongste (Johan)

    2002-01-01

    textabstractSymptoms of atopic asthma often disappear around puberty. The authors recently demonstrated that this clinical remission is accompanied with ongoing airways inflammation in most subjects. The discrepancy between lack of symptoms and persistent airway inflammation

  6. Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome

    Directory of Open Access Journals (Sweden)

    Valencia M

    2015-09-01

    Full Text Available Marcelo Valencia,1 Ana Fresán,2 Yoram Barak,3 Francisco Juárez,1 Raul Escamilla,4 Ricardo Saracco41Division of Epidemiological and Psychosocial Research, 2Division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico; 3Psychiatry Department, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente, Mexico City, MexicoBackground: New approaches to assess outcome in schizophrenia include multidimensional measures such as remission, cognition, psychosocial functioning, and quality of life. Clinical and psychosocial measures have been recently introduced to assess functional outcome.Objective: The study presented here was designed to examine the rates of symptomatic remission, psychosocial remission, global functioning, and clinical global impressions in a sample of schizophrenia outpatients in order to assess functional remission and to identify predictive factors for functional remission.Methods: A total of 168 consecutive Mexican outpatients receiving pharmacological treatment at the National Institute of Psychiatry in Mexico City were enrolled in a cross-sectional study. Symptomatic remission was assessed according to the definition and criteria proposed by the Remission in Schizophrenia Working Group using the Positive and Negative Symptom Scale. Psychosocial remission was assessed according to Barak criteria using the Psychosocial Remission in Schizophrenia scale. Functioning was measured with the Global Assessment of Functioning, and clinical outcome with the Clinical Global Impressions (CGI Scale.Results: Findings showed that 45.2% of patients fulfilled the symptomatic remission criteria, 32.1% achieved psychosocial remission, and 53% reported adequate functioning. However, the combination of these three outcome criteria – symptomatic, psychosocial remission, and functioning – indicated that 14.9% of the

  7. Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state

    DEFF Research Database (Denmark)

    Gandjbakhch, Frédérique; Conaghan, Philip G; Ejbjerg, Bo;

    2011-01-01

    In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective w...... was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state....

  8. Outcome after discontinuation of infliximab in patients with inflammatory bowel disease in clinical remission

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Molazahi, Akbar; Ainsworth, Mark Andrew

    2012-01-01

    Abstract Objective. To investigate duration of remission, including risk factors for relapse and response to retreatment with infliximab (IFX), in patients with Crohn's disease (CD) and ulcerative colitis (UC) who had discontinued IFX while in clinical remission. Methods. Observational, single......%) experienced complete clinical remission when retreated with IFX after relapse. Conclusion. While the short-term prognosis seems favorable, the majority of patients who discontinue IFX while in remission relapse over time. The response to retreatment with IFX at relapse seems favorable in this subpopulation....

  9. Effect of thalidomide on clinical remission in children and adolescents with refractory Crohn disease: a randomized clinical trial.

    Science.gov (United States)

    Lazzerini, Marzia; Martelossi, Stefano; Magazzù, Giuseppe; Pellegrino, Salvatore; Lucanto, Maria Cristina; Barabino, Arrigo; Calvi, Angela; Arrigo, Serena; Lionetti, Paolo; Lorusso, Monica; Mangiantini, Francesca; Fontana, Massimo; Zuin, Giovanna; Palla, Gabriella; Maggiore, Giuseppe; Bramuzzo, Matteo; Pellegrin, Maria Chiara; Maschio, Massimo; Villanacci, Vincenzo; Manenti, Stefania; Decorti, Giuliana; De Iudicibus, Sara; Paparazzo, Rossella; Montico, Marcella; Ventura, Alessandro

    2013-11-27

    Pediatric-onset Crohn disease is more aggressive than adult-onset disease, has high rates of resistance to existing drugs, and can lead to permanent impairments. Few trials have evaluated new drugs for refractory Crohn disease in children. To determine whether thalidomide is effective in inducing remission in refractory pediatric Crohn disease. Multicenter, double-blind, placebo-controlled, randomized clinical trial of 56 children with active Crohn disease despite immunosuppressive treatment, conducted August 2008-September 2012 in 6 pediatric tertiary care centers in Italy. Thalidomide, 1.5 to 2.5 mg/kg per day, or placebo once daily for 8 weeks. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks. All responders continued to receive thalidomide for an additional minimum 52 weeks. Primary outcomes were clinical remission at week 8, measured by Pediatric Crohn Disease Activity Index (PCDAI) score and reduction in PCDAI by ≥25% or ≥75% at weeks 4 and 8. Primary outcomes during the open-label follow-up were clinical remission and 75% response. Twenty-eight children were randomized to thalidomide and 26 to placebo. Clinical remission was achieved by significantly more children treated with thalidomide (13/28 [46.4%] vs 3/26 [11.5%]; risk ratio [RR], 4.0 [95% CI, 1.2-12.5]; P = .01; number needed to treat [NNT], 2.86). Responses were not different at 4 weeks, but greater improvement was observed at 8 weeks in the thalidomide group (75% response, 13/28 [46.4%] vs 3/26 [11.5%]; RR, 4.0 [95% CI, 1.2-12.5]; NNT = 2.86; P = .01; and 25% response, 18/28 [64.2%] vs 8/26 [30.8%]; RR, 2.1 [95% CI, 1.1-3.9]; NNT = 2.99; P = .01). Of the nonresponders to placebo who began receiving thalidomide, 11 of 21 (52.4%) subsequently reached remission at week 8 (RR, 4.5 [95% CI, 1.4-14.1]; NNT = 2.45; P = .01). Overall, 31 of 49 children treated with thalidomide (63.3%) achieved clinical remission, and 32 of 49

  10. Adolescents in clinical remission of atopic asthma have elevated exhaled nitric oxide levels and bronchial hyperresponsiveness

    NARCIS (Netherlands)

    L.M. van den Toorn (Leon); J-B. Prins (Jan-Bas); S.E. Overbeek (Shelley); H.C. Hoogsteden (Henk); J.C. de Jongste (Johan)

    2000-01-01

    textabstractSymptoms of atopic asthma often decrease or even seem to disappear around puberty. The aim of this study was to investigate whether this so-called clinical remission is accompanied by remission of airway inflammation, since symptoms relapse in a substantial

  11. Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn’s Disease Patients in Clinical Remission

    OpenAIRE

    Caterina Viganò; Roberta Calzolari; Paola Marianna Marinaccio; Cristina Bezzio; Federica Furfaro; Gabriella Ba; Giovanni Maconi

    2016-01-01

    Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Invento...

  12. Improving Clinical Remission Rates in Pediatric Inflammatory Bowel Disease with Previsit Planning

    Science.gov (United States)

    Savarino, Jeffrey R.; Kaplan, Jess L.; Winter, Harland S.; Moran, Christopher J.; Israel, Esther J.

    2016-01-01

    Inflammatory Bowel Disease (IBD) is a chronic autoimmune inflammatory disease of the intestine which can lead to malnutrition, poor quality of life, and colon cancer.1–4 Although there is no cure for the disease, clinical remission is the primary goal.5 The Center for Inflammatory Bowel Disease at MassGeneral Hospital for Children (MGHfC) adopted a Previsit Planning (PVP) model to identify and discuss symptomatic patients prior to their appointments to identify specific issues that impact disease management.6–8 The Registry from ImproveCareNow (ICN), the international Quality Improvement Collaborative for the management of Crohn's Disease and Ulcerative Colitis in pediatric and adolescent patients, was used to capture information from each ambulatory visit and hospitalization. Using the Model for Improvement framework, the team began a weekly review and made care recommendations of patients with active disease who were cared for by one physician. Interventions were modified over multiple Plan-Do-Study-Act (PDSA) improvement cycles to increase the number of providers and to include patients with mild or moderate disease activity.9 Feedback from the providers regarding this process was elicited via a REDCap survey and the clinical remission rate was tracked using the ICN Registry. The clinical remission rate for the Center's patients increased from 77% (n=597) in September 2014 to 83% (n=585) in August 2015 and has been maintained. 78% of responding providers indicated that they found the PVP recommendations helpful “all of the time”. One hundred percent who responded to the survey said that they have used at least one recommendation provided to them. PVP for management of a chronic disease in pediatrics is feasible, even in a high volume practice. This process at MGHfC has resulted in the improvement of clinical remission rate. PDSA cycles were used to document successes and failures to help guide the work. Ongoing expansion of this PVP practice to all

  13. Antibodies to Infliximab and Adalimumab in Patients with Rheumatoid Arthritis in Clinical Remission

    DEFF Research Database (Denmark)

    Eng, Grith P; Bendtzen, Klaus; Bliddal, Henning;

    2015-01-01

    Objective. To investigate if antibodies towards biological TNF-α inhibitors (anti-TNFi Abs) are present in patients with rheumatoid arthritis (RA) in clinical remission and to relate any anti-TNFi Abs to circulating level of TNF-α inhibitor (TNFi). Methods. Patients with RA, treated with infliximab....... These data suggest that continued infliximab treatment may be redundant in a proportion of RA patients treated with infliximab and in clinical remission....

  14. Remission-induction therapies for early rheumatoid arthritis: evidence to date and clinical implications.

    Science.gov (United States)

    Espinoza, Francisco; Fabre, Sylvie; Pers, Yves-Marie

    2016-08-01

    Recent guidelines on rheumatoid arthritis (RA) point to the importance of achieving remission as soon as possible during the course of the disease. The appropriate use of antirheumatic drugs is critical, particularly in early RA patients, before 24 weeks, since this is a 'window of opportunity' for treatment to modify disease progression. A treat-to-target strategy added to an aggressive therapeutic approach increases the chance of early remission, particularly in early RA patients. We conducted an overview of current therapeutic strategies leading to remission in early RA patients. We also provide interesting predictive factors that can guide the RA management strategy with regard to disease-modifying treatment and/or drug-free remission.

  15. Mixed-state bipolar I and II depression: time to remission and clinical characteristics.

    Science.gov (United States)

    Shim, In Hee; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

    2014-01-01

    We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. We investigated only inpatients and therefore could not comment on outpatients. These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state. © 2013 Elsevier B.V. All rights reserved.

  16. Specific probiotic dietary supplementation leads to different effects during remission and relapse in murine chronic colitis.

    Science.gov (United States)

    Zheng, B; van Bergenhenegouwen, J; van de Kant, H J G; Folkerts, G; Garssen, J; Vos, A P; Morgan, M E; Kraneveld, A D

    2016-01-01

    Although interest in using probiotics to prevent and treat intestinal diseases is increasing, the effects of specific probiotic strains still remain unclear. Here, we assess the therapeutic effects of two probiotic strains, Lactobacillus rhamnosus NutRes 1 and Bifidobacterium breve NutRes 204 on a dextran sodium sulphate (DSS)-induced chronic murine colitis model. The chronic colitis was induced by two DSS treatment cycles with a rest period of 10 days (the remission or resolution phase). The probiotic supplementation was started during the resolution phase, after the first DSS treatment cycle, and continued until the end of the experiment. In addition to clinical observations made during the experiment, cellular infiltration was measured along with mRNA expression of pro-inflammatory cytokines, T cell-associated cytokines, and Toll like receptors (TLR) in the inflamed colon after second DSS treatment cycle. L. rhamnosus, but not B. breve, rapidly and effectively improved the DSS-induced bloody diarrhoea during the resolution phase. However, a contradictory effect by both probiotic strains on the faecal condition was found after re-induction of colitis. The worsening of the faecal condition was accompanied by a reduced number of neutrophils and increased expression of interferon-γ in the colons of DSS-treated mice. Furthermore, an increased expression of TLR2, TLR6 and pro-inflammatory markers including chemokine (C-C motif) ligand 2, interleukin (IL)-1β, tumour necrosis factor α and IL-6 was found in DSS-treated mice with L. rhamnosus supplementation. These results indicate that therapeutic administration of specific probiotics might be beneficial during the resolution phase of colitis. However, caution should be taken as specific probiotic treatments reduce neutrophil influx, which may be the reason of exacerbation of chronic colitis.

  17. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials

    NARCIS (Netherlands)

    Felson, D.T.; Smolen, J.S.; Wells, G.; Zhang, B.; van Tuyl, L.H.D.; Funovits, J.; Aletaha, D.; Allaart, C.F.; Bathon, J.; Bombardieri, S.; Brooks, P.; Brown, A.; Matucci-Cerinic, M.; Choi, H.; Combe, B.; de Wit, M.; Dougados, M.; Emery, P.; Furst, D.; Gomez-Reino, J.; Hawker, G.; Keystone, E.; Khanna, D.; Kirwan, J.; Kvien, T.K.; Landewé, R.; Listing, J.; Michaud, K.; Martin-Mola, E.; Montie, P.; Pincus, T.; Richards, P.; Siegel, J.N.; Simon, L.S.; Sokka, T.; Strand, V.; Tugwell, P.; Tyndall, A.; van der Heijde, D.; Verstappen, S.; White, B.; Wolfe, F.; Zink, A.; Boers, M.

    2011-01-01

    Remission in rheumatoid arthritis (RA) is an increasingly attainable goal, but there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome measure in clinical trials. This work was undertaken to develop such a definition. A committee

  18. Micro-fabricated scaffolds lead to efficient remission of diabetes in mice.

    Science.gov (United States)

    Buitinga, Mijke; Assen, Frank; Hanegraaf, Maaike; Wieringa, Paul; Hilderink, Janneke; Moroni, Lorenzo; Truckenmüller, Roman; van Blitterswijk, Clemens; Römer, Gert-Willem; Carlotti, Françoise; de Koning, Eelco; Karperien, Marcel; van Apeldoorn, Aart

    2017-08-01

    Despite the clinical success of intrahepatic islet transplantation in treating type 1 diabetes, factors specific to this transplantation site hinder long-term insulin independence. The adoption of alternative, extravascular sites likely improve islet survival and function, but few locations are able to sufficiently confine islets in order to facilitate engraftment. This work describes a porous microwell scaffold with a well-defined pore size and spacing designed to guarantee islet retention at an extrahepatic transplantation site and facilitate islet revascularization. Three techniques to introduce pores were characterized: particulate leaching; solvent casting on pillared wafers; and laser drilling. Our criteria of a maximum pore diameter of 40 μm were best achieved via laser drilling. Transplantation studies in the epididymal fat of diabetic mice elucidated the potential of this porous scaffold platform to restore blood glucose levels and facilitate islet engraftment. Six out of eight mice reverted to stable normoglycemia with a mean time to remission of 6.2 ± 3.2 days, which was comparable to that of the gold standard of renal subcapsular islet grafts. In contrast, when islets were transplanted in the epididymal fat pad without a microwell scaffold, only two out of seven mice reverted to stable normoglycemia. Detailed histological evaluation four weeks after transplantation found a comparable vascular density in scaffold-seeded islets, renal subcapsular islets and native pancreatic islets. However, the vascularization pattern in scaffold-seeded islets was more inhomogeneous compared to native pancreatic islets with a higher vascular density in the outer shell of the islets compared to the inner core. We also observed a corresponding decrease in the beta-cell density in the islet core. Despite this, our data indicated that islets transplanted in the microwell scaffold platform were able to maintain a viable beta-cell population and restore glycemic control

  19. Periodontal pathogens participate in synovitis in patients with rheumatoid arthritis in clinical remission: a retrospective case-control study.

    Science.gov (United States)

    Kimura, Yuko; Yoshida, Shuzo; Takeuchi, Tohru; Kimura, Motoshi; Yoshikawa, Ayaka; Hiramatsu, Yuri; Ishida, Takaaki; Makino, Shigeki; Takasugi, Yoshihiro; Hanafusa, Toshiaki

    2015-12-01

    The objective of this study was to investigate the role of periodontal pathogens in RA in remission. Twenty-one patients with active RA and 70 patients in clinical remission, including 48 patients with synovitis [US power Doppler (USPD)(+) group] and 22 patients without synovitis [USPD(-) group] were clinically assessed by US. CRP, ESR, haemoglobin, MMP-3, RF and ACPA were measured. Antibody titres against four types of periodontal pathogen [Aggregatibacter actinomycetemcomitans, Eikenella corrodens (Ec), Porphyromonas gingivalis and Prevotella intermedia (Pi)] were analysed using ELISA. Musculoskeletal US examination showed that 68.6% of patients with RA in clinical remission exhibited synovitis. CRP, ESR, haemoglobin, MMP-3 and RF levels in both the USPD(+) and USPD(-) groups were clearly lower compared with the RA group in non-remission. The IgG serum antibody titre against Ec in the non-remission RA(+) group was significantly greater than that in the USPD(+) group, and the IgG antibody titre against Pi in the non-remission RA and USPD(+) groups was greater than in the USPD(-) group. More than half of RA patients in remission showed persistent synovitis. This synovitis may be associated with periodontal disease-causing Pi. Thus, treating periodontal disease should also be considered in order to achieve more profound remission of RA. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Persistent glucocorticoid resistance in systemic lupus erythematosus patients during clinical remission.

    Science.gov (United States)

    Melo, A K G; Melo, M R; Saramago, A B A; Demartino, G; Souza, B D B; Longui, C A

    2013-06-20

    Glucocorticoids (GCs) are key drugs in the treatment of systemic lupus erythematosus (SLE). GC dose reduction during remission is related to disease activity, GC dose used, length of treatment, and individual GC sensitivity. We compared GC receptor α (GRα) isoform and nuclear factor kappaB (NF-κB) messenger RNA quantitation and in vivo GC sensitivity between SLE patients during remission and healthy controls. We performed a cross-sectional study of 19 women aged 22-49 years, including 9 SLE patients in clinical remission taking ≤5 mg prednisone and 10 matched controls. We evaluated GC sensitivity using 2 cortisol suppression tests: a very-low-dose intravenous dexamethasone suppression test (VLD-IV-DST) and a low-dose oral dexamethasone suppression test. GRα and NF-κB mRNA were quantified using real-time polymerase chain reaction. Although basal cortisol and adrenocorticotropic hormone levels were similar between the groups, the percentage of cortisol reduction after the VLD-IV-DST was 56% lower in SLE patients than in controls (P = 0.014). GRα and NF-κB gene expression levels were similar between the groups. The low-dose oral dexamethasone test caused intense cortisol suppression in all individuals, limiting the ability of this test to discriminate individual GC sensitivity. A positive correlation was found between the extent of cortisol suppression in vivo (VLD-IV-DST) and the number of days elapsed since the last flare of lupus activity. Despite clinical remission, SLE patients displayed partial GC resistance recognized by the VLD-IV-DST. The mechanism of this resistance is unrelated to altered GRα and NF-κB mRNA expression.

  1. The discrepancy between clinical and ultrasonographic remission in rheumatoid arthritis is not related to therapy or autoantibody status.

    Science.gov (United States)

    Spinella, Amelia; Sandri, Gilda; Carpenito, Giacomo; Belletti, Lorenza; Mascia, Maria Teresa

    2012-12-01

    To evaluate the clinical remission by means of power Doppler ultrasonographic (PDUS) monitoring in a group of patients with rheumatoid arthritis (RA) in clinical remission (DAS28 therapy with DMARDS, anti-TNF, or no therapy in clinical remission according to ACR criteria and DAS 28 therapy with anti-TNF or other therapies showed similar US assessment without significant statistical differences. Among eleven patients that presented swollen and tender joints at the latest physical examination, which preceded US exam, just 5 patients had an US confirmation too. In the other patients, the PDUS did not confirm the presence of inflammation in the corresponding swollen and tender joints or showed a positive ultrasonographic assessment in other locations. The remission state is a great therapy target and not only through the biological therapy. Synovial inflammation could persist independently from type of therapy or autoantibody status.

  2. Design and validation of standardized clinical and functional remission criteria in schizophrenia

    Directory of Open Access Journals (Sweden)

    Mosolov SN

    2014-01-01

    Full Text Available Sergey N Mosolov,1 Andrey V Potapov,1 Uriy V Ushakov,2 Aleksey A Shafarenko,1 Anastasiya B Kostyukova11Department of Mental Disorders Therapy, Moscow Research Institute of Psychiatry, Moscow, Russia; 2Moscow Psychiatric Outpatient Services #21, Moscow, RussiaBackground: International Remission Criteria (IRC for schizophrenia were developed recently by a group of internationally known experts. The IRC detect only 10%–30% of cases and do not cover the diversity of forms and social functioning. Our aim was to design a more applicable tool and validate its use – the Standardized Clinical and Functional Remission Criteria (SCFRC.Methods: We used a 6-month follow-up study of 203 outpatients from two Moscow centers and another further sample of stable patients from a 1-year controlled trial of atypical versus typical medication. Diagnosis was confirmed by International Classification of Diseases Version 10 (ICD10 criteria and the Mini-International Neuropsychiatric Interview (MINI. Patients were assessed by the Positive and Negative Syndrome Scale, including intensity threshold, and further classified using the Russian domestic remission criteria and the level of social and personal functioning, according to the Personal and Social Performance Scale (PSP. The SCFRC were formulated and were validated by a data reanalysis on the first population sample and on a second independent sample (104 patients and in an open-label prospective randomized 12-month comparative study of risperidone long-acting injectable (RLAI versus olanzapine.Results: Only 64 of the 203 outpatients (31.5% initially met the IRC, and 53 patients (26.1% met the IRC after 6 months, without a change in treatment. Patients who were in remission had episodic and progressive deficit (39.6%, or remittent (15% paranoid schizophrenia, or schizoaffective disorder (17%. In addition, 105 patients of 139 (51.7%, who did not meet symptomatic IRC, remained stable within the period. Reanalysis of

  3. Evolução para remissão clínica completa em esclerose sistêmica Progression into clinical remission in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Leandro Antônio Cichoski

    2004-10-01

    patients with systemic sclerosis who underwent complete clinical remission, with no need of current drug treatment, after using D-Penicillamine. METHODS: chart review of patients diagnosed with systemic sclerosis (ARA, 1980 who were in remission after continuous ambulatory care. Data were collected on sex, race, and patient's age at the time of diagnosis, first manifestations, systemic involvement, laboratory profile and image tests, proposed treatment, drug response and full treatment period. RESULTS: patients were white, 1 male and 3 females, with an average age of 51.2 years at the time of the first symptoms. The average period of time from symptoms beginning to the diagnosis was 8.2 months. All patients showed skin alterations, systemic involvement, and reacting antinuclear antibodies on HEp-2 cells. In none of them the most specific autoantibodies for systemic sclerosis (anti-centromere and anti-Scl-70/topo I could be elicited. After introducing D-penicillamine the average period of time to reach remission was 60.7 ± 27.4 months. All four patients have been under no treatment for 31 to 120 months, and with no manifestations that point to disease activity, including absence of Raynaud's phenomenon. CONCLUSIONS: a the clinical spectrum of systemic sclerosis include patients who reach clinical remission after using D-penicillamine, staying under no medication for many years; b the absence of distinctive autoantibodies (anti-centromere and anti-Scl-70/topo I in our patients must be explored in a larger sample population; c the absence of specific autoantibodies for the disease might point to a better response to D-penicillamine therapy or to a higher possibility of spontaneous clinical remission.

  4. American College of Rheumatology/European League against Rheumatism Preliminary Definition of Remission in Rheumatoid Arthritis for Clinical Trials

    Science.gov (United States)

    Felson, David T.; Smolen, Josef S.; Wells, George; Zhang, Bin; van Tuyl, Lilian H. D.; Funovits, Julia; Aletaha, Daniel; Allaart, Renée; Bathon, Joan; Bombardieri, Stefano; Brooks, Peter; Brown, Andrew; Matucci-Cerinic, Marco; Choi, Hyon; Combe, Bernard; de Wit, Maarten; Dougados, Maxime; Emery, Paul; Furst, Dan; Gomez-Reino, Juan; Hawker , Gillian; Keystone, Edward; Khanna, Dinesh; Kirwan, John; Kvien, Tore; Landewé, Robert; Listing, Joachim; Michaud, Kaleb; Mola, Emilio Martin; Montie, Pam; Pincus, Ted; Richards, Pam; Siegel, Jeff; Simon, Lee; Sokka, Tuulikki; Strand, Vibeke; Tugwell, Peter; Tyndall, Alan; van der Heijde, Desirée; Verstappen, Suzan; White, Barbara; Wolfe, Fred; Zink, Angela; Boers, Maarten

    2010-01-01

    Background With remission in rheumatoid arthritis (RA) an increasingly attainable goal, there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome in clinical trials. Methods A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism and the Outcome Measures in Rheumatology Initiative (OMERACT) met to guide the process and review prespecified analyses from clinical trials of patients with RA. The committee requested a stringent definition (little, if any, active disease) and decided to use core set measures to define remission including at least joint counts and an acute phase reactant. Members were surveyed to select the level of each core set measure consistent with remission. Candidate definitions of remission were tested including those that constituted a number of individual measures in remission (Boolean approach) as well as definitions using disease activity indexes. To select a definition of remission, trial data were analyzed to examine the added contribution of patient reported outcomes and the ability of candidate measures to predict later good x-ray and functional outcomes. Results Survey results for the definition of remission pointed to indexes at published thresholds and to a count of core set measures with each measure scored as 1 or less (e.g. tender and swollen joint counts, CRP and global assessments on 0-10 scale). Analyses suggested the need to include a patient reported measure. Examination of 2 year follow-up data suggested that many candidate definitions performed comparably in terms of predicting later good x-ray and functional outcomes, although DAS28 based measures of remission did not predict good radiographic outcomes as well as did the other candidate definitions. Given these and other considerations, we propose that a patient be defined as in remission based on one of two definitions : 1: When their scores on the

  5. Clinical Observation in 31 Cases of Chronic Bronchitis at Remission Stage Treated with Bufei Keli

    Institute of Scientific and Technical Information of China (English)

    刘杨春; 王乃红; 王娜; 刘冠萍; 阎惠芳

    2003-01-01

    To observe the therapeutic effects of a Chinese drug Bufei Keli (补肺颗粒 granules for invigorating thelung) in the treatment of chronic bronchitis at remission stage, 62 cases were randomly divided into aThe results turned out to be that the short-term clinically controlled and markedly effective rate was77.42% and the long-term relapse-resisting markedly effective rate was 74.2% in the treatment group,which were obviously higher than 45.16% and 38.71% respectively in the control group (P<0.05). And theincrease in contents of SOD and CD3 and the decrease in LPO content in the treatment group were alsobigger than that in the control group (P<0.01). It is therefore concluded that Bufei Keli can improve qideficiency syndrome and raise the immunity of patients with chronic bronchitis, hence its effect ofresisting relapse of chronic bronchitis.

  6. Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?

    Science.gov (United States)

    Alivernini, Stefano; Tolusso, Barbara; Petricca, Luca; Bui, Laura; Di Sante, Gabriele; Peluso, Giusy; Benvenuto, Roberta; Fedele, Anna Laura; Federico, Franco; Ferraccioli, Gianfranco; Gremese, Elisa

    2017-07-01

    To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers. Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6remission (n=18) (DAS<1.6 and Psoriasis Area Severity Index (PASI)=0 for at least 6 months) achieved by MTX+anti-TNF (adalimumab 40 mg or etanercept 50 mg) with power Doppler (PDUS)-negative synovial hypertrophy underwent synovial tissue biopsy. Patients with RA with high/moderate disease naïve to treatment (n=50) were included as a comparison group. Immunostaining for cluster designation (CD)68, CD21, CD20, CD3, CD31 and collagen was performed. PDUS-negative patients with RA in remission showed lower histological scores for synovial CD68(+), CD20(+), CD3(+) cells and CD31(+) vessels and collagen deposition (p<0.05 for both lining and sublining) compared with PDUS-positive patients with RA with high/moderate disease. In addition, there was no significant difference in terms of lining and sublining CD68(+), CD20(+), CD3(+), CD31(+) cells and collagen comparing PDUS-negative patients with RA in remission and in LDA, respectively. On the contrary, PDUS-negative patients with PsA in remission showed higher histological scores for sublining CD68(+) (p=0.02) and CD3(+) cells (p=0.04) as well as CD31(+) vessels (p<0.001) than PDUS-negative patients with RA in remission. PDUS-negative patients with RA in remission have comparable synovial histological features than PDUS-negative patients with RA in LDA. However, patients with PsA in remission are characterised by a higher degree of residual synovial inflammation than patients with RA in remission, despite PDUS negativity under TNF inhibition. Published by the BMJ

  7. Micro-fabricated scaffolds lead to efficient remission of diabetes in mice

    NARCIS (Netherlands)

    Buitinga, M.; Assen, F.; Hanegraaf, M.; Wieringa, P.; Hilderink, J.; Moroni, L.; Truckenmuller, R.; Blitterswijk, C. Van; Romer, G.W.; Carlotti, F.; Koning, E. de; Karperien, M.; Apeldoorn, A. van

    2017-01-01

    Despite the clinical success of intrahepatic islet transplantation in treating type 1 diabetes, factors specific to this transplantation site hinder long-term insulin independence. The adoption of alternative, extravascular sites likely improve islet survival and function, but few locations are able

  8. Sequential Combination Therapy Leading to Sustained Remission in a Patient with SAPHO Syndrome.

    Science.gov (United States)

    Huber, C E; Judex, A G; Freyschmidt, J; Feuerbach, S; Schölmerich, J; Müller-Ladner, U

    2009-03-27

    The SAPHO syndrome represents a variety of clinically similar disorders with the key features of hyperostotic bone lesions in combination with chronic pustular skin disease. The respective pathophysiology of bone and joint manifestations in SAPHO syndrome is still a matter of discussion. For example it does not appear to represent reactive arthritis and HLA B27 antigen, with the latter being typically present in patients with spondyloarthopathies. Treatment of SAPHO syndrome is also not well established and consists of various antiinflammatory and antirheumatic drugs. Here, we report a female patient with active SAPHO syndrome suffering from sternal swelling of unknown origin that had been known for 10 years and a 4-year-history of severe lower back pain. Remarkable were also a typical pustulous palmar erythema associated with swelling and decreased motility of both MCP-I joints. Inflammation parameters were high with an ESR 68 mm/1st hour and a CRP of 19.6 mg/l. She was initially treated with rofecoxib and doxycycline, followed by sulfasalazine with only partial clinical response. Thereafter, both articular symptoms as well as cutaneous lesions responded well to a combination therapy with methotrexate and sulfasalazine. Thus, the case illustrates nicely that methotrexate in combination with another DMARD can be successfully applied to patients with long-term active SAPHO syndrome.

  9. Lesson of the month 2: Houssay phenomenon - hypopitutarism leading to remission of diabetes.

    Science.gov (United States)

    Pramanik, Subhodip; Bhattacharjee, Rana; Mukhopadhyay, Pradip; Ghosh, Sujoy

    2016-06-01

    Because of a pituitary insult and the subsequent loss of counter-regulatory hormones, individuals can experience increased sensitivity to insulin, hypoglycaemia or even complete amelioration of diabetes; this is known as the Houssay phenomenon. Severe dehydration following diarrhoea can lead to pituitary infarction causing hypopituitarism. We describe this situation in a patient with insulin-treated type-2 diabetes presenting with recurrent hypoglycaemia and cessation of insulin requirement along with weight loss, hypotension and hyponatraemia. Pituitary imaging revealed a partial empty sella and a synacthen stimulation test revealed an initial positive response but later loss of response, proving recent-onset pituitary dysfunction. Physicians should keep this possibility in mind while treating hypoglycaemia in stable diabetic individuals. Judicious supplementation of deficient hormones is of utmost importance.

  10. Ranking factors involved in diabetes remission after bariatric surgery using machine-learning integrating clinical and genomic biomarkers

    DEFF Research Database (Denmark)

    Pedersen, Helle Krogh; Gudmundsdottir, Valborg; Pedersen, Mette Krogh

    2016-01-01

    –protein interaction networks. Artificial neural networks allowing nonlinear correlations were trained to discriminate patients with and without surgery-induced diabetes remission, and the importance of each clinical and genetic parameter was evaluated. The approach highlighted insulin treatment, baseline HbA1c levels...

  11. Physical function continues to improve when clinical remission is sustained in rheumatoid arthritis patients.

    Science.gov (United States)

    Radner, Helga; Alasti, Farideh; Smolen, Josef S; Aletaha, Daniel

    2015-08-11

    To investigate the course of functional status assessed by health assessment questionnaire (HAQ) in rheumatoid arthritis (RA) patients with sustained clinical remission (REM). In recent RA clinical trials, we identified patients with subsequent visits of ≥24 weeks in clinical REM according to the disease activity score using 28-joint counts including C-reactive protein (DAS28) (≤2.6), or simplified disease activity index (SDAI) (≤3.3). Area under the curve (AUC) and mean HAQ scores throughout the time in sustained REM were compared using t test, analyses of variance (ANOVA) and adjusted general linear modeling (GLM) with repeated measures. In Cox regression analyses, the time to regain full physical function was modeled. Sensitivity analyses were performed in patients of sustained SDAI low disease activity (LDA; SDAI ≤11). A total of 610 out of 4364 patients achieved sustained DAS28 REM (14%) and 252 SDAI REM (5.8%). ANOVA testing for linear trend showed significant decrease of mean HAQ from week 0 (start of REM) to week 24, regardless of REM criteria used. AUC of HAQ throughout 24 weeks of REM was higher in DAS28 compared to SDAI REM (p ≤0.01). GLM adjusting for covariates showed significant decrease of monthly HAQ scores from week 0 to 24 (DAS28: 0.276, 0.243, 0.229, 0.222, 0.219, 0.209 to 0.199; p = 0.0001; SDAI: 0.147, 0.142, 0.149, 0.129, 0.123, 0.117 to 0.114; p = 0.029). Similarly, a decrease of HAQ over time was found in patients of sustained SDAI LDA. In DAS28 REM, the chance of regaining full physical function was higher for female (hazard ratio HR [95% confidence interval]: 1.41 [1.13-1.76]) and early RA patients (disease duration ≤2 years: HR 1.29 [1.01-1.65]); in SDAI REM no significant differences were found. Physical function continues to improve if the target of REM or LDA is sustained. The stringency of the remission criteria determines achievement of the best possible functional improvement.

  12. Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis.

    Science.gov (United States)

    Sung, Yoon Kyoung; Cho, Soo Kyung; Kim, Dam; Yoon, Bo Young; Choi, Chan Bum; Cha, Hoon Suk; Choe, Jung Yoon; Chung, Won Tae; Hong, Seung Jae; Jun, Jae Bum; Kang, Young Mo; Kim, Jinseok; Kim, Tae Hwan; Kim, Tae Jong; Koh, Eunmi; Lee, Choong Ki; Lee, Jisoo; Lee, Shin Seok; Lee, Sung Won; Lee, Hye Soon; Lee, Yeon Ah; Park, Sung Hoon; Yoo, Dae Hyun; Yoo, Wan Hee; Bae, Sang Cheol

    2016-12-01

    Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

  13. Four-year clinical remission of type 1 diabetes mellitus in two patients treated with sitagliptin and vitamin D3.

    Science.gov (United States)

    Pinheiro, Marcelo Maia; Pinheiro, Felipe Moura Maia; Torres, Margareth Afonso

    2016-01-01

    Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by autoimmune destruction of pancreatic beta cells and inadequate insulin production. Remission criteria in T1DM take into account serum levels of C-peptide and glycosylated hemoglobin, as well as the dose of insulin administered to the patient. However, remission of T1DM lasting longer than 1 year is rare. We describe here the cases of two young women who presented with positive glutamic acid decarboxylase (GAD) antibody and classic clinical manifestations of T1DM. Both patients had a prior history of Hashimoto's thyroiditis. They were initially treated with a basal-bolus regimen of insulin (glargine and lispro/glulisine). Once their blood glucose levels were controlled, they were started on oral sitagliptin 100 mg and vitamin D3 5000 IU daily. After this therapy, both patients achieved clinical diabetes remission for 4 years, along with a decrease in anti-GAD antibody levels. These benefits were probably associated with immunological effects of these medications. Inhibition of dipeptidyl peptidase 4 (DPP-4) in animal models deregulates Th1 immune response, increases secretion of Th2 cytokines, activates CD4(+)CD25(+)FoxP3(+) regulatory T-cells and prevents IL-17 production. Vitamin D3 also activates CD4(+)CD25(+)FoxP3(+) regulatory T-cells, and these medications combined can improve the immune response in patients with new-onset T1DM and probably promote sustained clinical remission.

  14. [Clinical features of depression in the remission phase of paranoid schizophrenia].

    Science.gov (United States)

    Petrova, N N; Vishnevskaya, O A

    2013-01-01

    Phenomenological and pathogenetic features of depression developed in the remission phase of paranoid schizophrenia were studied in 75 patients (mean age 44.9±1.22 years). Depression was diagnosed in 58.7% patients. It has been shown that the psychopathological structure of depression was not homogenous and 63.6% cases were atypical. In 25% patients, depressive disorders were psychogenic. Depression concomitant with anxiety disorders was most common. Depression in the phase of remission developed most often in female patients older than 39 years and in male patients younger than 39 years. Cognitive function was not impaired in patients with depression in the remission phase of paranoid schizophrenia.

  15. BALO’S CONCENTRIC SCLEROSIS: CLINICAL CASE ОF REMISSION

    Directory of Open Access Journals (Sweden)

    L. V. Lorina

    2017-01-01

    Full Text Available Objective. Case report of a rare form of multiple sclerosis, Balo’s concentric sclerosis (BCS.Materials and methods. 66 year old female patient L., admitted with complaints of gait disorder with tendency to fall towards the left side, left upper limb weakness and decreased memory. Neurological examination revealed left sided hemiparesis, and left sided positive Romberg’s test. Contrast brain magnetic resonance imaging (MRI was performed. Treatment was prescribed as well as dynamic follow up during the course of 1.5 years.Results. Based on complaints, clinical picture and MRI result, patient was diagnosed with an atypical form of multiple sclerosis, Balo’s concentric sclerosis. The main diagnostic method used confirm the diagnosis was contrast brain MRI: Non homogenous circular-form space occupying lesion with dimensions 3.7 × 3.4 × 3.5 cm was visualized in the supraventricular area of right parietal lobe with increased and decreased signals on T2 and T1 weighted images respectively. Following intravenous administration of contrast substance, an increased T1-WI signal is observed along the periphery of the described lesion in the right parietal lobe. MRI conclusion: brain demyelination disease with large foci in the right post-frontal lobe region, typical of Balo’s concentric sclerosis. Following the acute clinical state, cytostatic and immunomodulation therapy was prescribed. MRI dynamic observation revealed decrease in dimensions of the significantly enhanced concentric areas. Follow up demonstrated marked remission.Conclusion. This clinical case is of interest due to the rarity of this disease. The basis of diagnosis in our study was MRI investigation which allows for in vivo diagnosis of this pathology. These observations confirm the fact that timely use of modern methods of treatment can achieve not only stabilization of the patients’ state, but also positive clinical and MRI dynamics.

  16. Continual Maintenance of Remission Defined by the ACR/EULAR Criteria in Daily Practice Leads to Better Functional Outcomes in Patients with Rheumatoid Arthritis.

    Science.gov (United States)

    Shidara, Kumi; Nakajima, Ayako; Inoue, Eisuke; Hoshi, Daisuke; Sugimoto, Naoki; Seto, Yohei; Tanaka, Eiichi; Momohara, Shigeki; Taniguchi, Atsuo; Yamanaka, Hisashi

    2017-02-01

    To evaluate longterm functional outcomes in rheumatoid arthritis (RA) based on the number of times that the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) or the 28-joint Disease Activity Score (DAS28) remission criteria were fulfilled. Patients with RA who participated in all 6 data collections in an observational cohort from 2008 to 2010 and who fulfilled the DAS28 remission criteria at baseline were studied. Patients were classified by the number of times they fulfilled the ACR/EULAR [Boolean trial, Boolean practice, Simplified Disease Activity Index (SDAI), or Clinical Disease Activity Index (CDAI)] or DAS28 remission criteria at each collection. The OR for the Japanese version of the Health Assessment Questionnaire (J-HAQ) progression, based on the number of times each set of remission criteria was fulfilled, were calculated by logistic regression. A total of 915 patients were studied. The OR (95% CI) for J-HAQ progression were 0.54 (0.33-0.87), 0.55 (0.33-0.92), 0.48 (0.28-0.82), 0.29 (0.16-0.51), 0.24 (0.13-0.47), and 0.07 (0.03-0.15) for those fulfilling the Boolean trial remission from 1 to 6 times. This tendency was also observed for the other 4 criteria. The OR (95% CI) for J-HAQ progression in patients who achieved remission at all 6 data collections were 0.07 (0.03-0.14) for the Boolean practice, 0.10 (0.05-0.20) for the SDAI, and 0.07 (0.04-0.15) for the CDAI, whereas 0.15 (0.08-0.29) for the DAS28. Continual fulfillment of any remission criteria was strongly effective in preventing patients from progression of functional disability; however, the ACR/EULAR criteria appear to be preferable.

  17. Weekly injection of histaglobulin produces long-term remission in chronic urticaria: A prospective clinical study

    Directory of Open Access Journals (Sweden)

    Gurumoorthy Rajesh

    2016-01-01

    Conclusions: Histaglobulin was found to be effective in producing long-term remission and it reduced the antihistamine requirement as well. Thus, it can serve as an effective alternative to existing treatment modalities.

  18. An evaluation of molecular and clinical remission in rheumatoid arthritis by assessing radiographic progression

    OpenAIRE

    2013-01-01

    Objectives. To determine whether molecular remission defined by a multi-biomarker disease activity (MBDA) score predicts a reduced risk of joint damage progression, and whether the MBDA score can augment existing classifications of remission. Methods. The study examined 271 visits for 163 RA patients in the Leiden Early Arthritis Cohort. The MBDA score and other variables from each visit were evaluated for prediction of progression [change in Sharp–van der Heijde Score (ΔSHS) >3] over the ens...

  19. [Clinical study of prejudicing autochthonous speech act (thought)--acceleration of the activity in the remission process of schizophrenia].

    Science.gov (United States)

    Kato, S

    1997-01-01

    Schizophrenics occasionally experience guilty feeling at having insulted someone such as having said "You fool" or "Die" to a new acquaintance. They also experience guilty feeling from autochthonous thought, a feeling of having prejudiced his neighbour. This latter autochthonous thought is considered to be closely related with the former prejudicing speech act. The author would provisionally call these phenomenons of prejudice, prejudicing autochthonous speech act (or prejudicing autochthonous thought), particularly in the case in which the object of prejudice is an intimate real other, or a co-presenting other. Based on his own nine cases, the author has first described the clinical characteristics of this symptom, and then developed psychopathological considerations to draw a attention to the therapeutic importance of this symptom. On the symptomatological ground, the prejudicing autochthonous speech act (thought) belongs to psychomotor verbal hallucinations (J. Séglas), more precisely to the soliloquy type of this hallucination. On the clinical ground, this symptom is likely to follow auditory hallucination caused by an acute state or that of recovery period from this state. Furthermore, it is not infrequent that general improvement as well as remission follow the appearance of this symptom. This symptomatological change of the center of gravity, that is, the gradual transition from auditory hallucination to prejudicing autochthonous speech act (thought) is considered to correspond to a change of the patient's position in relation to others. This position, once experienced passively, is now experienced actively. In other words, the patient, coming out of an acute psychotic state and opening to an intersubjective world, is confronted with a high tension relationship with others. The prejudicing autochthonous speech act (thought) appears in this situation, to restore the patient's own subjectivity in coping with the pressure of real others. In this case, this

  20. The prevalence of clinical remission in RA patients theated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry

    NARCIS (Netherlands)

    Punder, de Yvonne M.R.; Fransen, Jaap; Kievit, Wietske; Houtman, Pieternella M.; Visser, Henk; Laar, van de Mart A.F.J.; Riel, van Piet L.C.M.

    2012-01-01

    Objectives. To evaluate the prevalence of clinical remission and minimal disease activity according to the ACR/European League Against Rheumatism (EULAR) remission, DAS-28 <2.6 and minimal disease activity (MDA) criteria, and to compare the extent of residual disease activity with disability in RA p

  1. Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission : An open randomized clinical trial (EUFEST)

    NARCIS (Netherlands)

    Boter, Han; Peuskens, Joseph; Libiger, Jan; Fleischhacker, W. Wolfgang; Davidson, Michael; Galderisi, Silvana; Kahn, Rene S.

    2009-01-01

    Background: Predefined response and remission criteria may hold more clinical relevance than mean scores on rating scales. We compared the effectiveness of low doses of haloperidol and regular doses of second generation antipsychotics (SGAs) on >= 50% response and remission. Methods: In an open rand

  2. Four-year clinical remission of type 1 diabetes mellitus in two patients treated with sitagliptin and vitamin D3

    Science.gov (United States)

    Pinheiro, Felipe Moura Maia; Torres, Margareth Afonso

    2016-01-01

    Summary Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by autoimmune destruction of pancreatic beta cells and inadequate insulin production. Remission criteria in T1DM take into account serum levels of C-peptide and glycosylated hemoglobin, as well as the dose of insulin administered to the patient. However, remission of T1DM lasting longer than 1 year is rare. We describe here the cases of two young women who presented with positive glutamic acid decarboxylase (GAD) antibody and classic clinical manifestations of T1DM. Both patients had a prior history of Hashimoto’s thyroiditis. They were initially treated with a basal-bolus regimen of insulin (glargine and lispro/glulisine). Once their blood glucose levels were controlled, they were started on oral sitagliptin 100 mg and vitamin D3 5000 IU daily. After this therapy, both patients achieved clinical diabetes remission for 4 years, along with a decrease in anti-GAD antibody levels. These benefits were probably associated with immunological effects of these medications. Inhibition of dipeptidyl peptidase 4 (DPP-4) in animal models deregulates Th1 immune response, increases secretion of Th2 cytokines, activates CD4+CD25+FoxP3+ regulatory T-cells and prevents IL-17 production. Vitamin D3 also activates CD4+CD25+FoxP3+ regulatory T-cells, and these medications combined can improve the immune response in patients with new-onset T1DM and probably promote sustained clinical remission. Learning points: The use of sitagliptin and vitamin D3 in patients with new-onset type 1 diabetes mellitus (T1DM) may help decrease the daily insulin requirement by delaying beta cell loss and improving endogenous insulin production. The use of sitagliptin and vitamin D3 in new-onset T1DM could help regulate the imbalance between Th17 and Treg cells. Age 14 years or above, absence of ketoacidosis and positive C-peptide levels in patients with T1DM are good criteria to predict prolonged T1DM remission. The

  3. Clinical Characteristics of Rheumatoid Arthritis Patients Achieving Functional Remission with Six Months of Biological DMARDs Treatment.

    Science.gov (United States)

    Miwa, Yusuke; Takahashi, Ryo; Ikari, Yuzo; Maeoka, Airi; Nishimi, Shinichiro; Oguro, Nao; Hayashi, Tomoki; Hatano, Mika; Isojima, Sakiko; Yanai, Ryo; Kasama, Tsuyoshi; Toyoshima, Yoichi; Inagaki, Katsunori; Sanada, Kenji

    2017-01-01

    Objective Although previous studies have reported the prognostic factors for functional remission, no reports have cited the predictive factors. Our aim was to study the predictive factors for functional remission, which is a treatment goal in rheumatoid arthritis (RA), after receiving biological disease-modifying antirheumatic drugs (bDMARDs) treatment for six months. Methods The study consisted of 333 RA patients treated with bDMARDs for six months. The following patient characteristics were investigated: age, gender, disease duration, type of bDMARDs, baseline steroid and methotrexate dosage, and levels of serum rheumatoid factor, matrix metalloprotease, anti-cyclic citrullinated peptides antibody, tumor necrosis factor-α, and interleukin-6. In our evaluation, we used the Simplified Disease Activity Index (SDAI) for RA disease activity, health assessment questionnaire disability index (HAQ-DI) for activity of daily living, Short Form (SF)-36 for quality of life, and Hamilton Depression Rating Scale (HAM-D) or Self-rating Depression Scale (SDS) to determine the patients' depression status. The subjects were divided into two groups: patients with HAQ-DI≤0.5 and HAQ-DI>0.5 at 6 months. Results A univariate analysis comparing a group of RA patients without functional remission (n=68) showed that the patients with functional remission (n=164) had the following in common compared with those without remission: younger age, shorter disease duration, lower baseline steroid dosage, lower SDAI, lower HAQ-DI, higher SF-36, and lower HAM-D. Only lower HAQ-DI scores and "mental health" score on the SF-36 were detected using a logistic regression analysis. Conclusion These findings suggested that RA patients with lower HAQ-DI and lower depression scores at baseline were more likely to achieve functional remission using bDMARDs treatment than those without these variables.

  4. The good EULAR response at the first year is strongly predictive of clinical remission in rheumatoid arthritis: results from the TARAC cohort.

    Science.gov (United States)

    Darawankul, Budsakorn; Chaiamnuay, Sumapa; Pakchotanon, Rattapol; Asavatanabodee, Paijit; Narongroeknawin, Pongthorn

    2015-01-01

    The purpose of this study was to identify the prevalence and prognostic factors of clinical remission in patients with rheumatoid arthritis (RA). The Thai Army Rheumatoid Arthritis Cohort (TARAC) patients were included if baseline data were available. Clinical remission was defined as 28-joint count disease activity scores (DAS28) EULAR response at the end of the first year of treatment (OR 2.75, 95 % CI 1.08-6.99, p = 0.03) were associated with clinical remission in univariate analysis. In multivariate regression analysis, only a good EULAR response at the first year was significantly correlated with clinical remission in this study (OR 3.1, 95 % CI 1.15-8.36, p = 0.03). Although remission is currently a treatment goal in patients with RA, only one-seventh of patients have achieved sustained clinical remission in clinical practice. The good EULAR response at the end of the first year was an independent predictive factor of clinical remission.

  5. Four-year clinical remission of type 1 diabetes mellitus in two patients treated with sitagliptin and vitamin D3

    Directory of Open Access Journals (Sweden)

    Marcelo Maia Pinheiro

    2016-12-01

    Full Text Available Type 1 diabetes mellitus (T1DM is a chronic disease characterized by autoimmune destruction of pancreatic beta cells and inadequate insulin production. Remission criteria in T1DM take into account serum levels of C-peptide and glycosylated hemoglobin, as well as the dose of insulin administered to the patient. However, remission of T1DM lasting longer than 1 year is rare. We describe here the cases of two young women who presented with positive glutamic acid decarboxylase (GAD antibody and classic clinical manifestations of T1DM. Both patients had a prior history of Hashimoto’s thyroiditis. They were initially treated with a basal-bolus regimen of insulin (glargine and lispro/glulisine. Once their blood glucose levels were controlled, they were started on oral sitagliptin 100 mg and vitamin D3 5000 IU daily. After this therapy, both patients achieved clinical diabetes remission for 4 years, along with a decrease in anti-GAD antibody levels. These benefits were probably associated with immunological effects of these medications. Inhibition of dipeptidyl peptidase 4 (DPP-4 in animal models deregulates Th1 immune response, increases secretion of Th2 cytokines, activates CD4+CD25+FoxP3+ regulatory T-cells and prevents IL-17 production. Vitamin D3 also activates CD4+CD25+FoxP3+ regulatory T-cells, and these medications combined can improve the immune response in patients with new-onset T1DM and probably promote sustained clinical remission.

  6. Differences in Predictive Factors for Sustained Clinical Remission with Abatacept Between Younger and Elderly Patients with Biologic-naive Rheumatoid Arthritis: Results from the ABROAD Study.

    Science.gov (United States)

    Sekiguchi, Masahiro; Fujii, Takao; Matsui, Kiyoshi; Murakami, Kosaku; Morita, Satoshi; Ohmura, Koichiro; Kawahito, Yutaka; Nishimoto, Norihiro; Mimori, Tsuneyo; Sano, Hajime

    2016-11-01

    To differentiate predictive factors for sustained clinical remission between elderly and younger patients with rheumatoid arthritis (RA) receiving abatacept (ABA) as an initial biological disease-modifying antirheumatic drug. The study involved 277 biologic-naive patients with RA with high or moderate disease activity, who were treated with intravenous ABA and evaluated for 48 weeks in 43 Japanese hospitals and rheumatology clinics (the ABatacept Research Outcomes as a First-line Biological Agent in the Real WorlD study: UMIN000004651). Predictive factors associated with sustained clinical remission defined by the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) during the 24-48-week or 36-48-week periods were determined in elderly (≥ 65 yrs, n = 148) and younger patient groups (< 65 yrs, n = 129) using logistic regression analysis. Clinical remission was achieved at 24 and 48 weeks in 35.1% and 36.5% of patients in the elderly group and 34.9% and 43.4% in the younger group, respectively. In elderly patients, anticitrullinated protein antibody (ACPA) positivity and a lower DAS28-CRP score were significantly associated with sustained clinical remission; however, a lower Health Assessment Questionnaire-Disability Index (HAQ-DI) score was not related to sustained clinical remission. In younger patients, lower DAS28-CRP and HAQ-DI scores were predictive factors for sustained clinical remission, whereas ACPA positivity was not a useful predictive factor for sustained clinical remission. Although the effectiveness of ABA in biologic-naive patients with RA was equally recognized in elderly and younger patients, the baseline clinical characteristics associated with sustained clinical remission were substantially different.

  7. The value of power Doppler ultrasound in patients with rheumatoid arthritis in clinical remission: Reclassifying disease activity?

    Science.gov (United States)

    Vergara, Facundo; Ruta, Santiago; Rosa, Javier; Marín, Josefina; García-Mónaco, Ricardo; Soriano, Enrique R

    2017-03-18

    The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients. We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS28<2.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively. Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28. Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  8. Pulse cyclophosphamide therapy and clinical remission in atypical hemolytic uremic syndrome with anti-complement factor H autoantibodies.

    Science.gov (United States)

    Boyer, Olivia; Balzamo, Eve; Charbit, Marina; Biebuyck-Gougé, Nathalie; Salomon, Rémi; Dragon-Durey, Marie-Agnès; Frémeaux-Bacchi, Véronique; Niaudet, Patrick

    2010-05-01

    We report 3 children with atypical hemolytic uremic syndrome associated with anti-complement factor H (CFH) autoantibodies who presented with sustained remission with low antibody titers and normal kidney function after plasma exchanges (PEs) and cyclophosphamide pulses. The 3 children initially presented with acute vomiting, fatigue, gross hematuria, hypertension, hemolytic anemia, thrombocytopenia, nephrotic syndrome, and acute kidney injury. C3 levels were normal in patients 1 and 3 and low in patient 2 (0.376 mg/mL [0.376 g/L]). CFH antibody titers were increased (15,000 to > 32,000 arbitrary units [AU]). Patient 1, an 11-year-old boy, was treated with 12 PEs, leading to a decrease in CFH antibody titer (to 800 AU). A first relapse 1 month later was treated with 6 PEs and 4 rituximab infusions. A second relapse 3 months later required 5 PEs, and the patient received oral steroids (0.5 mg/d/kg body weight) and 5 cyclophosphamide pulses (1 g/1.73 m(2)), leading to sustained remission with normal kidney function (estimated glomerular filtration rate [eGFR], 120 mL/min/1.73 m(2) [2.0 mL/s/1.73 m(2)]) and a stable decrease in CFH antibody titer (to 2,000 AU) 3 years later. Patient 2, a 5-year-old boy, required dialysis therapy for 2 weeks. He received 3 plasma infusions without remission. Six PEs associated with 2 cyclophosphamide pulses (0.5 g/1.73 m(2)) and steroids (1 mg/d/kg body weight) led to rapid remission, with eGFR of 107 mL/min/1.73 m(2) [1.78 mL/s/1.73 m(2)] and a prolonged decrease in CFH antibody titer after 15 months (1,300 AU). Patient 3, a 16-month-old boy, was treated with oral steroids (1 mg/d/kg body weight), 2 PEs, and 2 cyclophosphamide pulses (0.5 g/1.73 m(2)), resulting in a stable decrease in CFH antibody titer to 276 AU. Kidney function quickly normalized (eGFR, 110 mL/min/1.73 m(2) [1.83 mL/s/1.73 m(2)]) and has remained normal after 14 months. All 3 patients show a homozygous deletion mutation of the CFHR1 and CFHR3 genes

  9. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi;

    2008-01-01

    OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5...... exercise were statistically significantly associated with remission. CONCLUSION: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials...

  10. Clinical profiles for seizure remission and developmental gains after total corpus callosotomy.

    Science.gov (United States)

    Iwasaki, Masaki; Uematsu, Mitsugu; Hino-Fukuyo, Naomi; Osawa, Shin-ichiro; Shimoda, Yoshiteru; Jin, Kazutaka; Nakasato, Nobukazu; Tominaga, Teiji

    2016-01-01

    This study was aimed to determine what preoperative profiles were associated with seizure remission after corpus callosotomy and whether such seizure outcome was associated with the postoperative developmental outcome. This retrospective study included 26 consecutive patients with childhood onset epilepsy who underwent one-stage total corpus callosotomy at our institution and were followed up for a minimum of 1 year. The age at surgery ranged from 13 months to 32 years (median 6 years). The association between postoperative seizure freedom and preoperative profiles, post-operative developmental gains was examined. Five patients achieved seizure freedom (Engel class I), and 10 patients achieved worthwhile reduction of seizures (class III), whereas the remaining patients had a class IV outcome. All five seizure-free patients had "lack of abnormal magnetic resonance imaging findings", "lack of proven etiology of seizures", and underwent "surgery at age 6 years or younger". These three factors were associated with seizure freedom (pseizure freedom than in those without (pseizure remission can be achieved after total corpus callosotomy in subsets of patients with medically-uncontrolled epilepsy, and suggested that a better developmental outcome can be expected in patients benefiting from seizure freedom. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  11. Clinical response and symptomatic remission in short- and long-term trials of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder

    Directory of Open Access Journals (Sweden)

    Mattingly Greg W

    2013-01-01

    Full Text Available Abstract Background Despite the overall high degree of response to pharmacotherapy, consensus is lacking on how to judge clinical response or define optimal treatment/remission when treating adults with attention-deficit/hyperactivity disorder (ADHD. This study examined clinical response and symptomatic remission in analyses of 2 studies of lisdexamfetamine dimesylate (LDX in adults with ADHD. Methods In a 4-week, double-blind, forced-dose trial, adults with ADHD were randomized to LDX 30, 50, and 70 mg/day (mg/d or placebo. In a second, open-label, follow-up trial, adults entering from the 4-week study were titrated to an “optimal” LDX dose (30 mg/d [n=44], 50 mg/d [n=112], and 70 mg/d [n=171] over 4 weeks, and maintained for 11 additional months. The ADHD Rating Scale IV (ADHD-RS-IV with adult prompts and the Clinical Global Impressions-Improvement (CGI-I scale assessed efficacy. Clinical response was defined, post hoc, as ≥30% reduction from baseline in ADHD-RS-IV and CGI-I rating of 1 or 2; symptomatic remission was defined as ADHD-RS-IV total score ≤18. Log rank analysis examined overall significance among the treatment groups in time to response or remission. Results Four hundred and fourteen participants in the 4-week study and 345 in the open-label, extension study were included in the efficacy populations. All LDX groups improved by ADHD-RS-IV and CGI-I scores in both studies. In the 4-week study (n=414, 69.3% responded and 45.5% achieved remission with LDX (all doses; 37.1% responded and 16.1% achieved remission with placebo; time (95% CI to median clinical response (all LDX doses was 15.0 (15.0, 17.0 days and to remission was 31.0 (28.0, 37.0 days (P Conclusion In the long-term study, with open-label, dose-optimized LDX treatment, most adults with ADHD achieved clinical response and/or symptomatic remission; almost two-thirds maintained symptomatic remission over the remaining 11 months. Trial registration Clinical Trial

  12. Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice.

    Science.gov (United States)

    Masri, Karim R; Shaver, Timothy S; Shahouri, Shadi H; Wang, Shirley; Anderson, James D; Busch, Ruth E; Michaud, Kaleb; Mikuls, Ted R; Caplan, Liron; Wolfe, Frederick

    2012-06-01

    To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.

  13. Persistent remission of Graves` disease or evolution from Graves' disease to Hashimoto's thyroiditis in childhood - a report of 6 cases and clinical implications.

    Science.gov (United States)

    Smyczńyska, Joanna; Cyniak-Magierska, Anna; Stasiak, Magdalena; Karbownik-Lewińska, Małgorzata; Lewiński, Andrzej

    2014-01-01

    The main clinical manifestations of autoimmune thyroid diseases are Graves' disease (GD) and Hashimoto's thyroiditis (HT). Graves' disease is the cause of most cases of hyperthyroidism in childhood. Indications for radical therapy (surgery or 131I treatment) in children are still a matter of discussion, as sustained (sometimes very long) remission of GD is possible, while the radical therapy almost always leads to hypothyroidism. Spontaneous evolution from GD with hyperthyroidism to HT with hypothyroidism may also be observed. The aim of the study was to analyze the clinical course of 6 cases of hyperthyroid girls with GD in whom a normalization of previously increased autoantibodies against thyrotropin (TSH) receptor (anti-TSHR) was observed together with a significant increase in autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg), with concomitant hypo- or euthyroidism but no recurrence of hyperthyroidism. Patients' age at diagnosis ranged from 5.0 to 16.5 years. Two (2) patients had Turner syndrome, another one (1), diabetic, was on insulin therapy. In all the girls, antithyroid drugs were administered and euthyroid state was achieved during the first 2.0-3.5 months of the treatment. Mild side effects were observed in only one case. The therapy was continued up to 1.5-4.0 years. Relapses during the therapy were observed in 2 cases. Up to now, no relapses have been observed for 0.5-7.5 years since the therapy withdrawal in 5 patients (1 patient was lost to follow-up), 2 patients are currently treated with levothyroxine due to hypothyroidism. It seems that the prolonged pharmacotherapy with antithyroid drugs, followed by observation after remission of hyperthyroidism, may be an appropriate therapeutic option at least in some children with GD as they can be cured without radical therapy and the potential risks of such treatment.

  14. [Remission in pediatric rheumatology].

    Science.gov (United States)

    Huppertz, H-L

    2013-05-01

    After definition of disease activity, improvement and deterioration and establishing large international research alliances, the new biologicals could be tested in patients with juvenile idiopathic arthritis (JIA) in controlled studies and the effectiveness could be shown. More frequently than ever before even children with polyarticular JIA achieved a state without residual disease activity indicating the need for a definition of remission. The Wallace criteria have attained a large circulation and define inactive disease and remission under and without antirheumatic medication. However, they are not associated with the prognosis. So far biomarkers or imaging cannot improve these clinical criteria. Although many patients achieve inactive disease few of them remain free of disease when all drugs have been stopped. Moreover, gene expression of children in remission still remains pathological. This confirms that children with JIA can be treated better and better but still cannot be cured.

  15. The Validity of the Different Versions of the Hamilton Depression Scale in Separating Remission Rates of Placebo and Antidepressants in Clinical Trials of Major Depression

    DEFF Research Database (Denmark)

    Kyle, Phillip Raphael; Lemming, Ole; Timmerby, Nina

    2016-01-01

    Abstract: Our objectivewas to validate the different versions of the Hamilton Depression Scale (HAM-D) both psychometrically (scalability) and clinically in discriminating antidepressants from placebo in terms of remission rates in an 8-week clinical trial in the acute treatment of major depression...... in the longer HAM-D versions indicated smaller discriminating validity over placebo. The HAM-D6 indicated a dose effect on remission for vortioxetine in both moderate and severe major depression. The brief HAM-D6 was thus found superior to HAM-D17, HAM-D21, and HAM-D24 both in terms of scalability...

  16. The short-term outcome of neurotic disorders in the community - demographic and clinical predictors of remission.

    Science.gov (United States)

    Tennant, C; Hurry, J; Bebbington, P

    1981-06-01

    A one month longitudinal study of neurotic disorders in a London community was carried out, using the Present State Examination, a structured psychiatric interview. Remission of disorder at the one month follow-up was not significantly associated with demographic variables, although remission was somewhat more common in young single males of higher social class. Remission was significantly related to recent onset of disorder and there was a tendency toward lower rates of both medical consultation and prescription of psychotropic medication in the follow-up period. Surprisingly, perhaps, initial severity of the disorder and syndrome type did not predict remission. The implications of these findings are discussed.

  17. Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study.

    Science.gov (United States)

    Akdemir, Gülşah; Heimans, Lotte; Bergstra, Sytske Anne; Goekoop, Robbert J; van Oosterhout, Maikel; van Groenendael, Johannes H L M; Peeters, André J; Steup-Beekman, Gerda M; Lard, Leroy R; de Sonnaville, Peter B J; Grillet, Bernard A M; Huizinga, Tom W J; Allaart, Cornelia F

    2017-09-28

    To determine the 5-year outcomes of early remission induction therapy followed by targeted treatment aimed at drug-free remission (DFR) in patients with early arthritis. In 12 hospitals, 610 patients with early (25 points in 5 years. Five years of DFR-steered treatment in patients with early RA resulted in almost normal functional ability without clinically relevant joint damage across treatment groups. Patients who achieved early remission had the best clinical outcomes. There were no differences between the randomisation arms. SDFR is a realistic treatment goal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Evaluation of the clinical efficiency of tocilizumab therapy, by using DAS 28, SDAI, CDAI indices and new 2011 EULAR/ACR remission criteria in patients with rheumatoid arthritis

    OpenAIRE

    2012-01-01

    Objective: to evaluate the clinical efficiency of tocilizumab (TCZ) from the DAS 28, SDAI, and CDAI indices and to estimate remission rates from the European League Against Rheumatism (EULAR) criteria, and the new remission criteria proposed by the EULAR and the American College of Rheumatology (ACR) in 2011. Subjects and methods. Forty-two patients with rheumatoid arthritis (RA) who had received 6 infusions of TCZ in an intravenous dose of 8 mg/kg at a 4-week interval during stable therapy w...

  19. Limited Clinical Value of Periablative Changes of Serum Markers in the Prediction of Biochemical Remission in Patients with Papillary Thyroid Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Heeyoung; Kim, Seongjang; Kim, Injoo; Kim, Keunyoung; Kim, Sojung; Kim, Bo Hyun; Kim, Sang Soo; Kyung, Jeon Yoon [Pusan National Univ., Busan (Korea, Republic of)

    2013-12-15

    Remnant thyroid ablation and 1-year stimulated thyroglobulin (sTg) measurement are recommended for those who have undergone total thyroidectomy for differentiated thyroid cancer. The serum Tg kinetics in such patients are still unclear. This study was designed to evaluate whether the periablative change in serum markers can predict biochemical remission in papillary thyroid cancer (PTC) patients. We reviewed the medical records of 185 patients who were given high-dose radioactive iodine ablation therapy from January 2006 to December 2008. Serum Tg, TSH, and anti-Tg antibody (TgAb) were measured on the day and the following 10th day of radioactive iodine administration. We defined preablative sTg as Tg-1, postablative Tg measured on the 10th day of ablation as Tg-2, and the 1-year sTg as Tg-3. ΔTg means Tg2-Tg1. The same definition was applied to TgAb. A biochemical remission defined as Tg-3 < 2 ng/ml was achieved in 144 patients. Among the patients who achieved biochemical remission, PTC recurred in six during a median follow-up of 54 months. Tg-1<3.3 ng/ml (p<0.0001) predicted biochemical remission. Neither the ΔTg nor ΔTgAb was useful for predicting biochemical remission. On the evaluation of recurrence after biochemical remission, Tg-1 > 5.32 (p<0.0001) and Tg-3 > 2.9 (p=0.01) were proven to be statistically significant cutoff values for predicting recurrence. The ΔTg and ΔTgAb were not able to predict recurrence. For the prediction of biochemical remission or recurrence after biochemical remission, preablative sTg was demonstrated to be a statistically significant serum marker. However, short-term changes in biochemical markers including Tg and TgAb around the day of ablation could not provide useful clinical information about biochemical remission or disease recurrence. In conclusion, 1-year sTg measurement cannot be omitted with short-term change.

  20. Clinical Observation on Therapeutic Effect of Acupuncture and Moxibustion Treatment for Melanoderm's Peripheral Facial Paralysis at Remission Stage

    Institute of Scientific and Technical Information of China (English)

    MA Deng-shang; YANG Ling

    2007-01-01

    The traditional acupuncture and moxibustion therapies were adopted to treat 32cases of melanoderm's peripheral facial paralysis at remission stage, the effective rate was 93.8%, indicating that acupuncture and moxibustion therapies are effective for different races.

  1. Remission of classic rapid cycling bipolar disorder with levothyroxine augmentation therapy in a male patient having clinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Chen PH

    2015-02-01

    Full Text Available Pao-Huan Chen, Yu-Jui Huang Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan Abstract: The literature suggests that patients with bipolar disorder, particularly females, have greater vulnerability to rapid cycling features. Levothyroxine therapy might be potentially useful to attenuate mood instability in this patient group. In contrast, reports on male patients remain limited and controversial. Herein, we report a 32-year-old male patient who had bipolar 1 disorder for 12 years who developed a breakthrough rapid cycling course and first-onset clinical hypothyroidism at the age of 31 years during lithium therapy. After levothyroxine augmentation therapy was introduced, the patient had remission from the rapid cycling illness course along with normalization of serum levels of free T4 and thyroid stimulating hormone in the subsequent year. This observation suggested that investigation of both levothyroxine pharmacology and thyroid pathology in male patients with rapid cycling bipolar disorder might be of much value. Keywords: mood disorder, therapy, thyroid hormone

  2. The Effect of Eicosapentaenoic Acid Supplementation on Depression Remission: a Double-Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Karamati

    2011-12-01

    Full Text Available Introduction: There is some evidence that omega-3 fatty acids are associated with depression. The aim of this study was to compare the effects of eicosapentaenoic acid(EPA and placebo on mild to moderate depression. Methods: This double-blind randomized clinical trial was conducted on 54 outpatients with mild to moderate depression. Patients were randomly assigned to two groups: receiving EPA supplement or placebo. EPA and placebo groups received two identical capsules per day for 12 weeks. Each capsule contained 500 mg EPA or coconut oil. Hamilton Rating Scale for Depression(HRSD was used to determine the severity of depression at baseline, sixth and twelfth weeks after intervention. Results: Forty two patients(77.8% completed the 12-week intervention. A statistically significant difference was observed in mean scores of HRSD between EPA and placebo groups at the end of the study (P=0.001. Mean scores of HRSD decreased over time in both groups so that the analysis of variance for repeated measurements showed a statistically significant time effect(F=50.55, df=1.32, P<0.0001. Also, a statistically significant treatment effect of EPA compared to placebo was observed over time (treatment*time interaction, F=12.67, df=1.32, P=0.0001. Conclusion: The results of this study showed the efficacy of EPA in treatment of depression, so its use is recommended as an add-on to antidepressant medications in treatment of mild to moderate depression.

  3. [The systematization of epilepsy remissions].

    Science.gov (United States)

    Gromov, S A; Fedotenkova, T N

    1995-01-01

    Problems of systematization of remissions of epileptic seizures and epilepsy are discussed on the basis of clinical examination of 341 epileptic patients with seizures suppressed for many years and international classifications of epilepsy. A classification, developed by the authors, is presented. It reflects stages of regress of the disease in achievement of prolonged (for years) control of seizures. The possibility of drug dependence development in these therapeutic remissions is also taken into consideration.

  4. Evaluation of the clinical efficiency of tocilizumab therapy, by using DAS 28, SDAI, CDAI indices and new 2011 EULAR/ACR remission criteria in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Anastasia Sergeyevna Avdeyeva

    2012-01-01

    Full Text Available Objective: to evaluate the clinical efficiency of tocilizumab (TCZ from the DAS 28, SDAI, and CDAI indices and to estimate remission rates from the European League Against Rheumatism (EULAR criteria, and the new remission criteria proposed by the EULAR and the American College of Rheumatology (ACR in 2011. Subjects and methods. Forty-two patients with rheumatoid arthritis (RA who had received 6 infusions of TCZ in an intravenous dose of 8 mg/kg at a 4-week interval during stable therapy with disease-modifying antirheumatic drugs (DMARDs and glucocorticoids were examined. The EULAR criteria based on changes in the DAS 28 index and the SDAI and CDAI activity indices were used to evaluate the efficiency of TCZ therapy. Disease remission was assessed by the EULAR criteria and the new 2011 EULAR/ACR remission criteria. Results. The baseline values (median and interquartile range: 25-75th percentiles were 6.44 (5.87-7.04 for DAS 28; 45 (36.2-57 for SDAI; and 41.5 (32-53 for CDAI. At week 2 of TCZ therapy, there was a reduction in the levels of DAS 28 to 4.86 (4.28-5.29 and at week 4, there were decreases in SDAI to 22.6 (19.4-29.3 and CDAI to 21.9 (19.3-30, which remained until week 24 (p < 0.01. By week 24 of TCZ therapy, according to the EULAR criteria, 35 and 7 patients were observed to have good and moderate effects, respectively. By week 24, 30 (71%, 13 (31%, and 14 (33% patients achieved remission according to DAS 28, SDAI, and CDAI, respectively; low DAS 28 (2.6-3.2, SDAI (3.3-11, and CDAI (2.8-10 disease activity was observed in 5 (12%, 21 (50%, and 20 (47.6% patients, respectively; high SDAI and CDAI activities remained in 2 (4.8% patients. Remission was observed in 10 (24% patients according to the 2011 criteria. Conclusion. The obtained results of the 24-week study suggest that TCZ therapy is highly effective according to the changes in DAS 28, SDAI, CDAI activity indices and to the new 2011 EULAR/ACR remission criteria in severe RA

  5. Association of interferon-gamma and interleukin 10 genotypes and serum levels with partial clinical remission in type 1 diabetes

    DEFF Research Database (Denmark)

    Alizadeh, B Z; Hanifi-Moghaddam, P; Eerligh, P

    2006-01-01

    We studied whether serum interferon (IFN)-gamma or interleukin (IL)-10 levels and their corresponding functional polymorphic genotypes are associated with partial remission of type 1 diabetes (T1D). A multi-centre study was undertaken in patients with newly diagnosed T1D and matched controls. T1D...

  6. Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort.

    Science.gov (United States)

    Geng, Yan; Han, Jingjing; Deng, Xuerong; Zhang, Zhuoli

    2014-08-01

    The aim of this study was to evaluate the ultrasonographic synovitis in rheumatoid arthritis (RA) patients who reached clinical remission. Two hundred and two RA patients were enrolled into this study. One hundred and eleven RA patients achieved clinical remission with the treatment of synthetic and/or biologic disease-modifying anti-rheumatic drugs (DMARDs). Subclinical synovitis was assessed by power Doppler ultrasonography (PDUS). PD synovitis was semi-quantitatively recorded. Twenty-two joint regions were imaged: bilateral wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints. PD remission was defined as a total PD score of 0. The subclinical synovitis in the RA patients who achieved clinical remission was evaluated. The correlations between PD total scores and clinical/laboratory parameters were analyzed. Among the 111 RA patients who achieved clinical remission, 110 (99.1 %), 67 (60.4 %), 55 (49.5 %), 50 (45.0 %), and 54 (48.6 %) patients, respectively, satisfied DAS28 (CRP), DAS28 (ESR), CDAI, SDAI, and 2010 ACR/EULAR remission criteria. However, only 54 (48.6 %) patients achieved PD remission. Subclinical synovitis was detectable in 57 (51.8 %), 30 (44.8 %), 22 (40.0 %), 19 (38.0 %), and 18 (33.3 %) patients accordingly. On the contrary, 11 (26.8 %) out of 41 patients who fulfilled all five clinical remission criteria had evidence of subclinical synovitis. In those 91 patients who did not achieved clinical remission, total PD score was correlated with swollen joint counts (SJC), tender joint counts (TJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complex disease activity indexes (P peptide. Among those 57 patients with subclinical synovitis after reaching clinical remission, no correlation was found between PD total score and SJC, TJC, ESR, CRP, and complex disease activity indexes. Presence of subclinical synovitis is common in patients achieving clinical remission. The stricter clinical

  7. A Brief Clinical Tool to Estimate Individual Patients' Risk of Depressive Relapse Following Remission: Proof of Concept.

    Science.gov (United States)

    Judd, Lewis L; Schettler, Pamela J; Rush, A John

    2016-11-01

    The authors sought to determine whether symptoms experienced by formerly depressed patients after at least 8 weeks of remission can be used to identify their risk for relapse during the next 6 months. The study included 188 patients with major depressive disorder from the National Institute of Mental Health Collaborative Depression Study who had at least one Symptom Checklist-90 (SCL-90) assessment after at least 8 weeks of full remission from a depressive episode (defined as a value of 1 on the weekly psychiatric rating scale for all depressive conditions, recorded on Longitudinal Follow-Up Evaluation interviews). Mixed logistic regression was used to identify a set of SCL-90 items that were most predictive of relapse compared with nonrelapse within the next 6 months. Of 514 SCL-90 assessments completed after remission, 73 (14.2%) were followed by depressive relapse within 6 months. Seventeen SCL-90 items (including symptoms of depression, anxiety, and psychological vulnerability) significantly distinguished relapse from nonrelapse. Of these, a set of 12 symptoms maximally separated relapse from nonrelapse. Experiencing one or more of these symptoms had a sensitivity of 80.8% and a specificity of 51.2% for identifying a period in which a relapse occurred, with a positive predictive value of 21.5% and a negative predictive value of 94.2%. The relapse rate was 5.8% when none of the 12 symptoms were present, 16.4% when one to five symptoms were present, 34.1% when six to nine symptoms were present, and 72.7% when 10 or more symptoms were present. A brief symptom scale can be used to identify patients who, despite full remission from a depressive episode, are at substantial risk of relapse within the next 6 months, and this can be used to provide a basis for personalizing the intensity of follow-up visits.

  8. Non-systemic juvenile idiopathic arthritis outcome after reaching clinical remission with anti-TNF-α therapy: a clinical practice observational study of patients who discontinued treatment.

    Science.gov (United States)

    Iglesias, Estíbaliz; Torrente-Segarra, Vicenç; Bou, Rosa; Ricart, Silvia; González, María Isabel; Sánchez, Judith; Calzada, Joan; Antón, Jordi

    2014-08-01

    TNF-alpha-blocking agents (anti-TNF) used in juvenile idiopathic arthritis (JIA) are well established; however, time to withdraw is unclear. Neither prolonged nor tapering treatment seems to influence risk of relapse. Our aim was to assess relapse percentage after anti-TNF withdrawal of our non-systemic JIA patients after reaching clinical remission. A retrospective review of our non-systemic JIA patients in whom anti-TNF had been withdrawn due to inactive disease was achieved, between December 2000 and November 2011. We analyzed percentages of relapse according to JIA categories and antinuclear antibodies (ANA) positivity. n = 18 patients were included. Eighty-two percentage of patients relapsed after treatment withdrawal, and mean time to relapse was 3.04 months (SD 2.03). The percentage of relapse after anti-TNF discontinuation in the main JIA category was 88 % of negative rheumatoid factor polyarticular JIA and 80 % of persistent oligoarticular JIA. We did not find significant statistical differences according to ANA positivity (9 of 14 were ANA positive), and mean time to relapse (days) was 85.0 (SD 69.4) for ANA-positive versus 102.4 (SD 47.7) for ANA-negative patients (p = NS). Relapse percentage following anti-TNF discontinuation was high (82 %) and occurred within the first 3 months after it. No relationship regarding JIA subtype and ANA positivity was found.

  9. Metronomic Treatment with Low-Dose Trofosfamide Leads to a Long-Term Remission in a Patient with Docetaxel-Refractory Advanced Metastatic Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Jochen Greiner

    2010-01-01

    Full Text Available The treatment of metastatic prostate cancer patients refractory to androgen withdrawal and docetaxel therapy is currently discouraging and new therapeutic approaches are vastly needed. Here, we report a long-term remission over one year in a 68-year-old patient with metastatic docetaxel-refractory prostate cancer employing low-dose trofosfamide. The patient suffered from distant failure with several bone lesions and lymph node metastases depicted by a (11 C-Choline positron emission tomography/computerized tomography (PET/CT. After initiation of trofosfamide 100 mg taken orally once a day we observed a steadily decreasing PSA value from initial 46.6 down to 2.1 g/l. The Choline-PET/CT was repeated after 10 months of continuous therapy and demonstrated a partial remission of the bone lesions and a regression of all involved lymph nodes but one. Taken together we found an astonishing and durable activity of the alkylating agent trofosfamide given in a metronomic fashion. We rate the side effects as low and state an excellent therapeutic ratio of this drug in our patient.

  10. [The prevention of ulcer relapses in patients with an ulcerative anamnesis in clinical and endoscopic remission following the eradication of Helicobacter infection of the gastric mucosa].

    Science.gov (United States)

    Chakŭrski, I; Todorova, K; Penkova, M; Prodanova, M

    1999-01-01

    The contemporary scientific consensus recommends treatment of the Helicobacter pylori infection in patients with history of peptic ulcer independently of the stage of activity. The object of the study was to confirm the necessity for treatment of Helicobacter pylori infection in patients with duodenal peptic ulcer in stage of clinical and endoscopic remission. To investigation were submitted 55 patients divided into in two groups--30 patients treated with triple medicinal combination of metronidasol 2 x 20 mg, amoxycillin 2 x 1000 mg and metronidasol 3 x 500 mg for 7 days. The second group of 25 patients was without medicinal therapy. The observation continued for 12 months. The patients with eradicated Helicobacter pylori infection underwent significantly less relapses, while the quality of their life considerably improved.

  11. Evaluation of false remission in ulcerative colitis and the need for a revised disease activity index

    Directory of Open Access Journals (Sweden)

    Alaa Elgamal

    2014-01-01

    Conclusion About 70% of our patients with ulcerative colitis in clinical remission had an active disease. Clinical remission in ulcerative colitis can be best expressed as true and false remission depending on histological grading in a revised ulcerative colitis disease activity index. Some inflammatory markers can be useful for the detection of true remission.

  12. Recent Advances in the Clinical Management of Lead Poisoning.

    Directory of Open Access Journals (Sweden)

    Sina Kianoush

    2015-06-01

    Full Text Available Lead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.

  13. Lead - a preanalytical/analytical variable in clinical chemistry

    Directory of Open Access Journals (Sweden)

    Rašić-Mišić Ivana

    2014-01-01

    Full Text Available Lead is one of the most studied clinically important metals due its high toxicity and a high number of workers exposed to it. The interest toward Pb is elevated by the fact that children are especially susceptible to lead poisoning. Research regarding lead poisoning requires a complex, multi-disciplinary (clinical medical and clinical chemical approach. Monitoring human exposure to lead (intake, i.e. poisoning may be achieved by quantification of Pb in tissues and body fluids. For that reason, a number of accurate and reliable analytical methods for the determination of Pb (analytical/preanalytical variable were developed. An objective of this review paper is to provide key information necessary for proper interpretation of results of lead related clinical/laboratory tests. [Projekat Ministarstva nauke Republike Srbije, br. 172061

  14. 临床缓解类风湿关节炎患者的超声评估%Ultrasound assessment of rheumatoid arthritis patients with clinically remission

    Institute of Scientific and Technical Information of China (English)

    张斌; 张珠凤; 顾娟芳; 王宏智

    2016-01-01

    目的 探讨高频超声检查在亚临床RA评估中的价值.方法 选择达到DAS28缓解的RA患者共44例,对所有患者68个关节包括双侧颞下颌关节、胸锁关节、肩锁关节、肩关节、肘关节、腕关节、第1~5掌指关节、拇指指间关节、第2~5近端指间关节、第2~5远端指间关节、髋关节、膝关节、踝关节、跗关节、第1~5跖趾关节、第1~5趾间关节进行超声评估.分析超声滑膜内血流能量多普勒(PD)及灰度等级(GS)评分与患者性别、年龄、病程以及各项临床疾病活动指标:疼痛视觉模拟评分法(VAS)、晨僵时间、肿胀关节数(SJC)和压痛关节数(TJC)、健康评估问卷(HAQ)评分、受试者和医生分别对目前疾病状况的评估、ESR、CRP、RF、CCP抗体、简化疾病活动指数(SDAI)、DAS28-CRP、DAS28-ESR的相关性.超声滑膜炎关节指数评分与临床观察指标作Pearson或Spearman相关分析,2组均数比较采用两独立样本t检验.结果 纳入研究的44例RA患者中,达到ACR/EULAR2011缓解26例,达到ACR缓解标准19例,而达到超声缓解的仅3例.超声GS评分与病程、肿胀关节数之间存在相关性(r=0.602、0.470,P<0.01);超声PD评分则与患者疼痛评分、患者总体评分、ACR/EULAR2011、DAS28-ESR、DAS28-CRP呈正相关(r=0.323、0.337、0.329、0.360、0.343,P<0.05),同时与CRP、ESR、晨僵时间亦呈正相关关系(r=0.474、0.490、0.415,P<0.01).结论 大部分临床缓解RA患者中仍存在高频超声检查可检测到的亚临床滑膜炎,PD超声在反映RA疾病活动度方面较GS超声更有优势.%Objective To discuss the value of high frequency ultrasound for the evaluation of subclinical rheumatoid arthritis.Methods Forty-four rheumatoid arthritis patientswho reached disease activity score (DAS28) clinical remis-sion were included.Ultrasound assess were carried out in all 68 joints,including bilateral temporomandibular joints,sternoclavicular joint

  15. Clinical Observation of 200 Cases of Cough Illness in Remission%咳喘病缓解期治疗200例临床观察

    Institute of Scientific and Technical Information of China (English)

    徐宏

    2015-01-01

    Objective To investigate the disease in remission cough control measures.Methods July 2011-Sep-tember 2014 200 cases of clinic patients with chronic cough, the children are divided into groups according to age, youth group, middle-aged group, elderly group;cough disease into chronic bronchitis, asthmatic bronchitis, bronchial asth-ma;with a particular medicine in the summer“dog days” sticking corresponding points on the human back clinical ob-servation.Results The results showed that children′s group, the total efficiency of 98.4%, 90.5% youth group, the older group 77.6%.Chronic bronchitis best effect, the total efficiency of 82.8%.Conclusions Of remission reasonable comprehensive treatment can improve the cure rate, improvement rate of cough disease and reduce its incidence.%目的:探讨咳喘病缓解期的防治措施。方法收集2011年7月~2014年9月门诊慢性咳喘病患者200例,根据年龄分为少儿组、青年组、中年组、老年组;咳喘病分为慢性支气管炎、喘息性支气管炎、支气管哮喘;用特定的中药在夏季“三伏天”贴敷人体背部相应的穴位进行临床观察。结果显示少儿组总有效率98.4%、青年组90.5%、老年组77.6%。慢性支气管炎疗效最好,总有效率82.8%。结论通过缓解期合理的综合治疗,能够提高咳喘病的痊愈率、好转率、并降低其发病率。

  16. Budesonide induces complete remission in autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    Antal Csepregi; Christoph R(o)cken; Gerhard Treiber; Peter Malfertheiner

    2006-01-01

    AIM: Prednisone and azathioprine represent the standard treatment for autoimmune hepatitis (AIH). However, only 65% of the patients enter complete histological remission. Recently, budesonide (BUD) was reported to be a promising alternative. In this study we assessed the efficacy and safety of BUD in AIH.METHODS: Eighteen patients (12 women, 6 men; mean age 45.4±21 years) with AIH were treated with BUD (Budenofalk(R)) 3 mg thrice daily and followed up for at least 24 wk. Seven patients also had features of primary biliary cirrhosis (n = 5) or primary sclerosing cholangitis (n = 2). Advanced liver fibrosis or cirrhosis was present in 6 patients.RESULTS: Fifteen (83%) patients had a complete clinical and biochemical remission. Ten patients, including five with acute hepatitis, were given BUD as first-line therapy, of which seven enter remission. Three patients,two with liver cirrhosis, did not improve. All patients with second-line therapy experienced long-term remission.A histological remission was also seen in three patients.Clinically relevant BUD-induced side effects were recorded only in patients with liver cirrhosis (n = 4).CONCLUSION: BUD is effective in remission induction in the majority of our patients with AIH. Side effects and treatment failure was mainly observed in patients with liver cirrhosis.

  17. Remission of allergic rhinitis

    DEFF Research Database (Denmark)

    Bødtger, Uffe; Linneberg, Allan

    2004-01-01

    months and s-IgE levels of class 2 or greater against pollen (birch, grass, or mugwort). This was similar for AR to animals (cat or dog) or house dust mites (HDMs). Remission of AR was defined as AR at baseline but no rhinitis symptoms at follow-up and sensitization (s-IgE level class > or =2 at baseline...

  18. In rheumatoid arthritis patients treated with tocilizumab, the rate of clinical disease activity index (CDAI) remission at 24 weeks is superior in those with higher titers of IgM-rheumatoid factor at baseline.

    Science.gov (United States)

    Kawashiri, Shin-Ya; Kawakami, Atsushi; Iwamoto, Naoki; Fujikawa, Keita; Aramaki, Toshiyuki; Tamai, Mami; Yamasaki, Satoshi; Nakamura, Hideki; Origuchi, Tomoki; Ueki, Yukitaka; Migita, Kiyoshi; Mizokami, Akinari; Aoyagi, Kiyoshi; Eguchi, Katsumi

    2011-08-01

    We aimed to evaluate the efficacy of tocilizumab in patients with rheumatoid arthritis (RA), using the clinical disease activity index (CDAI), and to determine the baseline variables associated with CDAI remission. Fifty-eight patients with active RA were enrolled. We tried to evaluate whether baseline variables were associated with CDAI remission at 24 weeks. Twenty-two of the 58 patients (37.9%) had received tumor necrosis factor (TNF) inhibitors. The continuation rate of tocilizumab at 24 weeks was 87.9%. The seropositivity rates of IgM-rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies at baseline were both 91.4%. The rate of CDAI remission at 24 weeks was 20.7%. We selected baseline variables including age, gender, duration of disease, concomitant use of glucocorticoids, concomitant use of methotrexate (MTX), previous anti-TNF therapy, titer of anti-CCP antibodies (high or low toward median), titer of IgM-RF (high or low toward median), and CDAI, and found that a high titer of IgM-RF was the only variable to be associated with CDAI remission, according to univariate and logistic regression analyses. This is a new finding, and may be specific to tocilizumab as compared with previous observations in anti-TNF therapy.

  19. The short-term outcome of neurotic disorders in the community: the relation of remission to clinical factors and to "neutralizing' life events.

    Science.gov (United States)

    Tennant, C; Bebbington, P; Hurry, J

    1981-09-01

    A longitudinal study of neurotic disorder in the community showed that half the cases identified at first interview had remitted one month later. Remission was significantly related to four variables: recency of onset and of peak of the disorders, the occurrence of recent threatening life events and the occurrence of subsequent "neutralizing' life events. A neutralizing event was defined a priori as one which neutralized the impact of an earlier threatening life event or difficulty. One third of all remissions were caused by such an event. Remission of disorder was not significantly related to demographic variables, symptom severity, syndrome type, medical consultation or psychotropic drug prescription. The implications for neurotic disorder in the community are discussed, in particular its relation to life events and the favourable outcome in the absence of treatment.

  20. [Comparison of ACR/EULAR remission criterion of rheumatoid arthritis published in 2011 year with the other common remission criteria].

    Science.gov (United States)

    Lu, Xiao-yan; Li, Chun; Zhao, Jin-xia; Li, Zhan-guo

    2013-04-18

    To evaluate and compare the advantage and utility of the 2011 ACR/EULAR criterion and the other remission criteria of rheumatoid arthritis. The questionnaires for RA patients were used for the study. The remission rate and residual disease activity of RA patients were compared according to four criteria of remission, including 2011 ACR/EULAR remission criterion, DAS28, CDAI and ACR. Among the 310 cases, 254 effective questionnaires were obtained. The remission rates of ACR, CDAI,ACR/EULAR and DAS28 were 15.4%, 23.2%,25.2%,38.2%, respectively.ACR criteria is the most stringent criteria, the remission rate of ACR was significantly lower than the other three criteria (PEULAR, which were more suitable for clinical practice. Among the four criteria, ACR criteria is the most stringent criteria, DAS28 criteria is the laxest criteria, The CDAI and ACR/EULAR criteria were more suitable for clinical practice.

  1. Partial Remission Definition

    DEFF Research Database (Denmark)

    Andersen, Marie Louise Max; Hougaard, Philip; Pörksen, Sven

    2014-01-01

    of type 1 diabetes (T1D). Receiver operating characteristic curve (ROC) analysis was used to evaluate the predictive value of IDAA1c and age on partial C-peptide remission (stimulated C-peptide, SCP > 300 pmol/L). RESULTS: PR (IDAA1c ≤ 9) in the Danish and Hvidoere cohorts occurred in 62 vs. 61% (3 months......OBJECTIVE: To validate the partial remission (PR) definition based on insulin dose-adjusted HbA1c (IDAA1c). SUBJECTS AND METHODS: The IDAA1c was developed using data in 251 children from the European Hvidoere cohort. For validation, 129 children from a Danish cohort were followed from the onset...

  2. CLINICAL PICTURE AND THERAPEUTIC MANAGEMENT OF LEAD TOXICOSIS IN SHEEP

    Directory of Open Access Journals (Sweden)

    H. Zaneb, K. Pervez, M. S. Sarwar, S. Sindhu.

    2003-12-01

    Full Text Available The project was aimed at evaluation of comparative therapeutic efficacy of two treatment regimes for the treatment of lead poisoning in sheep. For this purpose 20, two-months-old, lambs of Buchi breed were used as experimental animals. Five animals were kept as healthy control, whereas the remaining 15 animals were given oral aqueous solution of lead acetate daily. The dose was started from 5 mg/kg bodyweight and was increased gradually till it reached 100 mg/kg body weight by the end of 2nd month when clinical toxicosis was observed. Clinical findings included diarrhea, hindquarter weakness and reduction of feed intake, accompanied by anemia and elevated blood lead levels up to 2.72 ppm. The 15 toxicated animals were divided into three groups A, B and C comprising of 5 animals each. Disodium calcium edetate, which was used to treat animals of group A, resulted in 52.7% fall in blood lead level in 5 days. A combination of disodium calcium edetate and thiamine hydrochloride was used to treat animals of group B, which showed 73.8% fall in blood lead levels. Group C served as untreated control. Thus, combination therapy appears to be more effective for treatment of lead toxicosis.

  3. The presence of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor on patients with rheumatoid arthritis (RA) does not interfere with the chance of clinical remission in a follow-up of 3 years.

    Science.gov (United States)

    da Mota, Licia Maria Henrique; Dos Santos Neto, Leopoldo Luiz; de Carvalho, Jozélio Freire; Pereira, Ivânio Alves; Burlingame, Rufus; Ménard, Henri A; Laurindo, Ieda Maria Magalhães

    2012-12-01

    Autoantibodies in early rheumatoid arthritis (RA) have important diagnostic value. The association between the presence of autoantibodies against cyclic citrullinated peptide and the response to treatment is controversial. To prospectively evaluate a cohort of patients with early rheumatoid arthritis (peptide antibodies (anti-CCP) and citrullinated anti-vimentin (anti-Sa) with the occurrence of clinical remission, forty patients diagnosed with early RA at the time of diagnosis were evaluated and followed for 3 years, in use of standardized therapeutic treatment. Demographic and clinical data were recorded, disease activity score 28 (DAS 28), as well as serology tests (ELISA) for RF (IgM, IgG, and IgA), anti-CCP (CCP2, CCP3, and CCP3.1) and anti-Sa in the initial evaluation and at 3, 6, 12, 18, 24, and 36 months of follow-up. The outcome evaluated was the percentage of patients with clinical remission, which was defined by DAS 28 lower than 2.6. Comparisons were made through the Student t test, mixed-effects regression analysis, and analysis of variance (significance level of 5%). The mean age was 45 years, and a female predominance was observed (90%). At the time of diagnosis, RF was observed in 50% of cases (RF IgA-42%, RF IgG-30%, and RF IgM-50%), anti-CCP in 50% (no difference between CCP2, CCP3, and CCP3.1) and anti-Sa in 10%. After 3 years, no change in the RF prevalence and anti-CCP was observed, but the anti-Sa increased to 17.5% (P = 0.001). The percentage of patients in remission, low, moderate, and intense disease activity, according to the DAS 28, was of 0, 0, 7.5, and 92.5% (initial evaluation) and 22.5, 7.5, 32.5, and 37.5% (after 3 years). There were no associations of the presence of autoantibodies in baseline evaluation and in serial analysis with the percentage of clinical remission during follow-up of 3 years The presence of autoantibodies in early RA has no predictive value for clinical remission in early RA.

  4. Evaluation of dose reduction versus standard dosing for maintenance of remission in patients with spondyloarthritis and clinical remission with anti-TNF (REDES-TNF): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Pontes, Caridad; Gratacós, Jordi; Torres, Ferran; Avendaño, Cristina; Sanz, Jesús; Vallano, Antoni; Juanola, Xavier; de Miguel, Eugenio; Sanmartí, Raimon; Calvo, Gonzalo

    2015-08-20

    Dose reduction schedules of tumor necrosis factor antagonists (anti-TNF) as maintenance therapy in patients with spondyloarthritis are used empirically in clinical practice, despite the lack of clinical trials providing evidence for this practice. To address this issue the Spanish Society of Rheumatology (SER) and Spanish Society of Clinical Pharmacology (SEFC) designed a 3-year multicenter, randomized, open-label, controlled clinical trial (2 years for inclusion and 1 year of follow-up). The study is expected to include 190 patients with axial spondyloarthritis on stable maintenance treatment (≥4 months) with any anti-TNF agent at doses recommended in the summary of product characteristics. Patients will be randomized to either a dose reduction arm or maintenance of the dosing regimen as per the official labelling recommendations. Randomization will be stratified according to the anti-TNF agent received before study inclusion. Patient follow-up, visit schedule, and examinations will be maintained as per normal clinical practice recommendations according to SER guidelines. The study aims to test the hypothesis of noninferiority of the dose reduction strategy compared with standard treatment. The first patients were recruited in July 2012, and study completion is scheduled for the end of April 2015. The REDES-TNF study is a pragmatic clinical trial that aims to provide evidence to support a medical decision now made empirically. The study results may help inform clinical decisions relevant to both patients and healthcare decision makers. EudraCT 2011-005871-18 (21 December 2011).

  5. Lead intoxication: clinic and diagnostic evaluation in children

    Directory of Open Access Journals (Sweden)

    Martínez-Riera Nora

    2012-03-01

    Full Text Available Poverty, poor nutrition, environmental and social injustice prevailing in Latin America are factorsthat determine the action of pollutants on children. Lead poisoning and pollution constitute apublic health problem throughout the world. Lead affects multiple organs: nervous system particularly,hematopoietic, renal, endocrine, bone and others. Objective: to assess clinical, biochemicaland vascular effects in children exposed to known source of lead. Materials and methods: Sevenchildren with defined source lead exposure were studied, general and specific lead laboratorywere made. Endothelial function and electrocardiographic parameters were assessed. Statistic:descriptive. Results: Age average was 6,2 years (DE± 1, 6, average haematocrit 31% (DE±0,02;hemoglobin average 10,2 g/dl (DE± 0,78. 100% presented hypochromia, microcitosis, anemiaand marked anisocytosis. Lead average: 37,9 ug/dl (DE±6,22, ALA-D average: 8,9 U/L (DE±4,5.No changes were found in lipid profile and kidney function. All presented microalbuminuriaand endothelial dysfunction. Conclusion: These results show the effects of environmental leadexposure that can result in children not occupationally exposed.

  6. TAILOR - tapered discontinuation versus maintenance therapy of antipsychotic medication in patients with newly diagnosed schizophrenia or persistent delusional disorder in remission of psychotic symptoms: study protocol for a randomized clinical trial.

    Science.gov (United States)

    Stürup, Anne Emilie; Jensen, Heidi Dorthe; Dolmer, Signe; Birk, Merete; Albert, Nikolai; Nielsen, Mai; Hjorthøj, Carsten; Eplov, Lene; Ebdrup, Bjørn H; Mors, Ole; Nordentoft, Merete

    2017-09-29

    The aim of the TAILOR trial is to investigate the effect of closely monitored tapering/discontinuation versus maintenance therapy with antipsychotic medication in patients with newly diagnosed schizophrenia or persistent delusional disorder and with minimum 3 months' remission of psychotic symptoms. Two hundred and fifty patients will be included from the psychiatric early intervention program, OPUS, in two regions in Denmark. Inclusion criteria are: ICD-10 diagnoses schizophrenia (F20, except F20.6) or persistent delusional disorder (F22), minimum 3 months' remission of psychotic symptoms and in treatment with antipsychotic medication (except clozapine). The patients will be randomized to maintenance therapy or tapering/discontinuation with antipsychotic medication in a 1-year intervention. The tapering/discontinuation group will be using a smartphone application to monitor early warning signs of psychotic relapse. Patients will be assessed at baseline, 1-, 2- and 5-year follow-up regarding psychotic and negative symptoms, side-effects of antipsychotic medication, social functioning, cognitive functioning, perceived health status, patient satisfaction, substance and alcohol use, sexual functioning and quality of life. The primary outcome will be remission of psychotic symptoms and no antipsychotic medication after 1 year. Secondary outcome measures will include: co-occurrence of remission of psychotic symptoms and 0-1-mg haloperidol equivalents of antipsychotic medication after 1-year intervention; antipsychotic dose; antipsychotic side effects; negative symptoms; social functioning; cognitive functioning; and patient satisfaction. Exploratory outcomes will include remission, clinical recovery, substance and alcohol use, sexual functioning, quality of life, self-beliefs of coping and user experience of support from health workers. Safety measures will include death, admissions to psychiatric hospital, severe self-harm and psychotic relapses. The TAILOR trial

  7. Functional remission and employment among patients with schizophrenia in Malaysia.

    Science.gov (United States)

    Dahlan, Rahima; Midin, Marhani; Shah, Shamsul Azhar; Nik Jaafar, Nik Ruzyanei; Abdul Rahman, Fairuz Nazri; Baharudin, Azlin; Das, Srijit; Sidi, Hatta

    2014-01-01

    The study aimed to determine the rates of functional remission and employment as well as the factors associated with functional remission among patients with Schizophrenia, receiving community psychiatric service in an urban setting in Malaysia. From a total of 250 patients randomly selected, 155 fulfilled the study requirement and were assessed on their functional remission status using the Personal and Social Performance Scale. The relationships between functional remission and socio-demographic factors, clinical factors, social support, symptom remission and rates of hospitalization were examined. The results revealed that 74% (n=115) of the respondents had functional remission with only 20% (n=31) currently employed. Functional remission was found to be significantly associated with good social support (84.4% versus 36.4% p<0.001, OR=9.487 [95% CI=4.008-22.457]); shorter illness duration of less than 10 years (81.2% versus 66.7% p=0.038, OR=2.167 [95% CI=1.035-4.535]); good medication compliance (79.1% versus 50.0% p=0.002, OR=3.778 [95% CI=1.570-9.090]); hospital admissions of lower than 3 per year (80.5% versus 44.4% p<0.001 OR=5.150 [95% CI=2.145-12.365]) and; symptomatic remission (87.3% versus 37.4% p<0.001 [95% CI=0.070 (0.029-0.168]). A multiple regression analysis revealed only social support, lower hospitalization rate and symptom remission, as significant predictors of functional remission. A majority of patients with Schizophrenia in this study achieved functional remission, however, only a small percentage of them were employed. Functional remission was influenced by severity of illness and levels of social support in these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Increase of interleukin-10-producing B cells associated with long-term remission after i.v. immunoglobulin treatment for pemphigus.

    Science.gov (United States)

    Kabuto, Miho; Fujimoto, Noriki; Tanaka, Toshihiro

    2016-07-01

    We present a refractory case of pemphigus vulgaris that achieved long-term remission after i.v. immunoglobulin treatment (IVIG). We evaluated the fluctuation of circulating interleukin-10-producing B cells (B10 cells) during the course in our case and other three patients with pemphigus treated with IVIG without clinical remission. B10 cells were observed predominantly in CD1d(-) , CD5(-) , CD9(-) and CD27(+) populations among CD19(+) cells in healthy controls, as well as in patients with pemphigus. The frequency of B10 cells among CD19(+) cells increased in our case, but not in the other three patients without clinical remission, which leads to speculation on the association between the increase of B10 cells and the achievement of long-term remission after IVIG treatment. © 2016 Japanese Dermatological Association.

  9. Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Christensen, Ib Jarle; Tarp, Ulrik;

    2010-01-01

    OBJECTIVE: To compare tumor necrosis factor alpha inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response. METHODS: The nationwide DANBIO registry...... collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n = 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment...

  10. Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission

    DEFF Research Database (Denmark)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Honoré, Per Gustaf Hartvig

    2009-01-01

    , cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment...... history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. RESULTS: In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations...

  11. Cytokines and intrathecal IgG synthesis in multiple sclerosis patients during clinical remission Citocinas e síntese intratecal de IgG em pacientes com esclerose múltipla durante remissão clínica

    Directory of Open Access Journals (Sweden)

    Carlos Otávio Brandão

    2005-12-01

    Full Text Available Cytokines and intrathecal IgG synthesis were determined in the cerebrospinal fluid (CSF and sera to evaluate inflammatory activity in multiple sclerosis (MS patients during clinical remission. Although the disease was stable, there had been a significant increase of proinflammatory cytokines such as TNFalpha and IFNgamma in the CSF and serum, with no significant changes of IL12 and IL10 production. The changes in the cytokine production patterns were associated with an increase of leukocytes in the CSF, as well as the presence of oligoclonal bands suggesting intrathecal IgG synthesis. These results suggest that even when the disease is clinically silent, one can observe inflammatory activity in these MS patients.Os níveis de citocinas e síntese intratecal de IgG foram dosados no líquido cefalorraquidiano (LCR e soro, com o objetivo de avaliar a atividade inflamatória em pacientes com esclerose múltipla durante remissão clínica. Foram detectados níveis elevados de citocinas pró-inflamatórias (TNFalfa e IFNgama no LCR e soro, sem alterações significativas na produção de IL12 e IL10. O perfil de produção das citocinas pró-inflamatórias estava associado ao aumento de leucócitos no LCR, assim como a presença de bandas oligoclonais IgG sugerindo síntese intratecal de IgG. Estes resultados sugerem que mesmo quando a doença está clinicamente silenciosa, a atividade inflamatória está presente nestes pacientes.

  12. Gene Expression Analysis of Peripheral Cells for Subclassification of Pediatric Inflammatory Bowel Disease in Remission

    NARCIS (Netherlands)

    Lierop, van P.P.E.; Swagemakers, S.M.; Bie, de C.I.; Middendorp, S.A.; Baarlen, van P.; Samsom, J.N.; Ijcken, van W.F.J.; Escher, J.C.; Spek, van der P.J.; Nieuwenhuis, E.E.S.

    2013-01-01

    Objective: In current clinical practice, optimal treatment of inflammatory bowel disease (IBD) aims at the induction and maintenance of clinical remission. Clinical remission is apparent when laboratory markers of inflammation are normal and clinical symptoms are absent. However, sub-clinical inflam

  13. Mucosal healing and deep remission: What does it mean?

    Science.gov (United States)

    Rogler, Gerhard; Vavricka, Stephan; Schoepfer, Alain; Lakatos, Peter L

    2013-01-01

    The use of specific terms under different meanings and varying definitions has always been a source of confusion in science. When we point our efforts towards an evidence based medicine for inflammatory bowel diseases (IBD) the same is true: Terms such as “mucosal healing” or “deep remission” as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered. It appears to be useful to first have a look at the development of terms and their definitions, to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials. The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms. It may also lead to a better defined use of those terms for future studies. The terms “mucosal healing” and “deep remission” have been introduced in recent years as new therapeutic targets in the treatment of IBD patients. Several clinical trials, cohort studies or inception cohorts provided data that the long term disease course is better, when mucosal healing is achieved. However, it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission. Clinical trials are under way to answer this question. Attention should be paid to clearly address what levels of IBD activity are looked at. In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists. PMID:24282345

  14. Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study.

    Science.gov (United States)

    Lee, Yvonne C; Cui, Jing; Lu, Bing; Frits, Michelle L; Iannaccone, Christine K; Shadick, Nancy A; Weinblatt, Michael E; Solomon, Daniel H

    2011-06-08

    Disease remission has become a feasible goal for most rheumatoid arthritis (RA) patients; however, patient-reported symptoms, such as pain, may persist despite remission. We assessed the prevalence of pain in RA patients in remission according to the Disease Activity Score (DAS28-CRP4) and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria. Data were analyzed from RA patients in the Brigham Rheumatoid Arthritis Sequential Study with data at baseline and 1 year. DAS28 remission was defined as DAS28-CRP4 EULAR remission criteria included (a) one or more swollen joints, (b) one or more tender joints, (c) C-reactive protein ≤1 mg/dl, and (d) patient global assessment score ≤1. Pain severity was measured by using the pain score from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ). The associations between baseline clinical predictors and MDHAQ pain at baseline and 1 year were assessed by using multivariable linear regression. Among the 865 patients with data at baseline and 1 year, 157 (18.2%) met DAS28-CRP4 remission criteria at both time points. Thirty-seven (4.3%) met the ACR/EULAR remission criteria at baseline and 1 year. The prevalence of clinically significant pain (MDHAQ pain ≥4) at baseline ranged from 11.9% among patients meeting DAS28-CRP4 remission criteria to none among patients meeting ACR/EULAR remission criteria. Patient global assessment, MDHAQ function, MDHAQ fatigue, MDHAQ sleep, and arthritis self-efficacy were significantly associated with MDHAQ pain in cross-sectional (P ≤ 0.0005) and longitudinal analyses (P ≤ 0.03). Low swollen-joint counts were associated with high MDHAQ pain in longitudinal analyses (P = 0.02) but not cross-sectional analyses. Other measures of inflammatory disease activity and joint damage were not significantly associated with MDHAQ pain at baseline or at 1 year. Clinically significant pain continues among a substantial proportion of patients in DAS28

  15. Lead

    Science.gov (United States)

    ... found? Who is at risk? What are the health effects of lead? Get educational material about lead Get certified as a Lead Abatement Worker, or other abatement discipline Lead in drinking water Lead air pollution Test your child Check and maintain your home ...

  16. Gene expression analysis of peripheral cells for subclassification of pediatric inflammatory bowel disease in remission

    NARCIS (Netherlands)

    P.P.E. van Lierop (Pieter); S.M.A. Swagemakers (Sigrid); C.I. de Bie (Charlotte); S. Middendorp; P. van Baarlen (Peter); J.N. Samsom (Janneke); W.F.J. van Ijcken (Wilfred); J.C. Escher (Johanna); P.J. van der Spek (Peter); E.E.S. Nieuwenhuis (Edward)

    2013-01-01

    textabstractObjective: In current clinical practice, optimal treatment of inflammatory bowel disease (IBD) aims at the induction and maintenance of clinical remission. Clinical remission is apparent when laboratory markers of inflammation are normal and clinical symptoms are absent. However, sub-cli

  17. Poor versus rich children with epilepsy have the same clinical course and remission rates but a less favorable social outcome: A population-based study with 25 years of follow-up.

    Science.gov (United States)

    Camfield, Carol; Camfield, Peter; Smith, Bruce

    2016-11-01

    To explore the influence of several estimates of family socioeconomic status on the long-term clinical course and social outcomes of children with epilepsy. The Nova Scotia childhood epilepsy cohort is population based and includes all children in this Canadian province who developed epilepsy between 1977 and 1985. Eligible patients had ≥10 years of follow-up. Children with childhood absence epilepsy were excluded. Total family income at seizure onset was assessed at seizure onset and classified as "poor" (first quintile), "adequate" (second to third quintiles), and "well-off" (fourth to fifth quintiles). We also assessed parental education and home ownership. Social outcome was assessed in those with normal intelligence who were ≥18 years of age at the end of follow-up using a semistructured interview that explored eight adverse effects. Of 584 patients, 421 (72%) were included. Average follow-up was 26 ± 5.6 years. Overall 137 families (33%) had "poor" income, 159 (38%) had "adequate income," and 125 (30%) were "well-off." Terminal remission of epilepsy occurred in 65% of the poor, 61% of the adequate, and 61% of the well-off (p = ns). Intractable epilepsy, status epilepticus, number of antiepileptic drugs (AEDs) used, and the number of generalized tonic-clonic or focal with secondary generalization seizures through the clinical course was the same in all groups. Home ownership did not predict remission. Neither paternal nor maternal education was associated with remission. Poor children had significantly more adverse social outcomes including failure to graduate from high school, unemployment, personal poverty, inadvertent pregnancy, and psychiatric diagnoses. In Nova Scotia with universal health care, coming from a poor or more affluent family does not seem to affect the clinical course or long-term seizure outcome of childhood epilepsy. Unfortunately children from poor families are less likely to have a good social outcome. Wiley Periodicals, Inc

  18. Effects of KIR ligand incompatibility on clinical outcomes of umbilical cord blood transplantation without ATG for acute leukemia in complete remission.

    Science.gov (United States)

    Tanaka, J; Morishima, Y; Takahashi, Y; Yabe, T; Oba, K; Takahashi, S; Taniguchi, S; Ogawa, H; Onishi, Y; Miyamura, K; Kanamori, H; Aotsuka, N; Kato, K; Kato, S; Atsuta, Y; Kanda, Y

    2013-11-29

    To clarify the effect of killer cell immunoglobulin-like receptor (KIR) ligand incompatibility on outcomes of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients in complete remission after single cord blood transplantation (CBT), we assessed the outcomes of CBT registered in the Japan Society for Hematopoietic Cell Transplantation (JSHCT) database. A total of 643 acute leukemia (357 AML and 286 ALL) patient and donor pairs were categorized according to their KIR ligand incompatibility by determining whether or not they expressed HLA-C, Bw4 or A3/A11 by DNA typing. A total of 128 patient-donor pairs were KIR ligand-incompatible in the graft-versus-host (GVH) direction and 139 patient-donor pairs were incompatible in the host-versus-graft (HVG) direction. Univariate and multivariate analyses showed no significant differences between the KIR ligand-incompatible and compatible groups in the GVH direction for both AML and ALL patients of overall survival, disease-free survival, relapse incidence, non-relapse mortality and acute GVH disease. However, KIR incompatibility in the HVG direction ameliorated engraftment in ALL patients (hazard ratio 0.66, 95% confidence interval 0.47-0.91, P=0.013). Therefore, there were no effects of KIR ligand incompatibility in the GVH direction on single CBT outcomes for acute leukemia patients without anti-thymocyte globulin use. However, it is necessary to pay attention to KIR incompatibility in the HVG direction for engraftment.

  19. Workplace-based clinical leadership training increases willingness to lead.

    Science.gov (United States)

    MacPhail, Aleece; Young, Carmel; Ibrahim, Joseph Elias

    2015-01-01

    The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline. Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme. Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years. Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users

  20. Remission in schizophrenia: applying recent consensus criteria to refine the concept.

    Science.gov (United States)

    Lasser, Robert A; Nasrallah, Henry; Helldin, Lars; Peuskens, Joseph; Kane, John; Docherty, John; Tronco, Anselmo Toledo

    2007-11-01

    Although the concept of remission has been widely accepted and utilized in depression and anxiety disorders, there has been much less emphasis on defining remission in schizophrenia. Recently, an expert consensus definition of remission in schizophrenia was proposed along specific operational criteria for the attainment of remission focusing on the three core dimensions of psychopathology identified within schizophrenia: psychoticism, disorganization and negative symptoms. To date, the criteria have been applied retrospectively to several clinical studies, and these have demonstrated that the proposed definition of remission correlates significantly with established measures of symptom severity, functioning and quality of life, and appears achievable for a significant proportion of patients receiving at least 3 months of pharmacotherapy. In this article we extend the notion of remission to include an examination of the possible association of several modifiable and unmodifiable factors and co-morbidities on remission status. We also propose an investigation into the likelihood of different patient populations in achieving remission as well as assessing the impact of remission on health care costs and family burden. Since cognitive dysfunction and negative symptoms may be strongly correlated with a lower likelihood of achieving remission, we recommend retrospective and/or prospective studies to determine the relationship between neurocognitive status and the predominance of negative symptoms at treatment start and the probability of achieving remission. Taken together, these studies should help identify key predictors of remission, further define the remitted state, reduce therapeutic pessimism, raise treatment expectations and chart a strategy for further research in this important area.

  1. Connecting Effective Immune Response, Fluorescent Granzyme B-like Peptide, Specific Peptide Binding Patterns, Patients with Cancer and Viral Infection, in Remission, Clinical Significance, and Liquid Biopsy.

    Science.gov (United States)

    Lo, Wai Chun Jennifer; Luther, Donald Gene

    2016-11-01

    Functional cytotoxic-T-lymphocytes (CTL) with granzyme B play an important role in an effective immune response to tumor growth and infection progression. Tumor cells and platelets in peripheral whole blood smears of cancer patients have shown the presence of innate binding targets for GP1R, a fluorescent synthetic Granzyme B-like peptide. It is not known if similar GP1R-binding targets and specific binding patterns are detectable in peripheral blood of patients with viral infection. It is also not known if a specific binding pattern may be associated with an effective immune response to indicate a favorable prognosis. We reviewed the GP1R-binding patterns in the peripheral blood smears of 5 patients in remission at the time of sampling (3 with cancer and 2 with flu-like symptoms) and a negative control. We show with fluoroscopic images that there are: 1) fluorescent GP1R-binding targets mostly in the cytoplasmic areas of nucleated cells in patients with breast and lung cancer who have longer survival, 2) intense fluorescent deposits mostly in the nuclear areas of segmented neutrophils in patients recovered from severe to mild flu-like symptoms, 3) discernible fluorescent deposits in the cytoplasmic areas of small lymphocyte-like elements and overall intense fluorescent stain in large cells in the patient with advanced pancreatic cancer who had shorter survival, 4) GP1R-binding targets in numerous platelet-like elements in all 5 patients. The control sample did not show similar binding patterns. The potential association between specific GP1R-binding patterns in peripheral blood samples and prognostic significance, and its use as liquid biopsy are discussed.

  2. Detection of sub-clinical lead toxicity in monocasters

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, B.D.; Krishnaswamy, K. [Food and Drug Toxicology Research Centre National Institute of Nutrition, Jamai Osmania (India)

    1995-06-01

    Lead poisoning has been documented since antiquity but occupational lead intoxication still continues to occur. Now there is a growing consensus that low levels of lead exposure often do not result in the manifestation of toxic symptoms, but may have subclinical toxicity on haemopoitic and renal system. Such toxicities are reported even at blood lead concentrations which were thought to be safe (60-80 {mu}g/dl) a decade ago. One of the several effects of lead, is inhibition of erythrocyte delta-aminolevulinic acid dehydratase (d-ALAD), rate limiting enzyme of the heme synthesis. Similar effect on d-ALAD has been reported even at the blood lead concentrations of 20-30 {mu}g/dl which are much below the toxic limits of 60 {mu}g/dl. Occupational lead nephropathy has been reported from several countries. Ultrastructural alteration in renal tubules, due to chronic exposure of lead, are seen in both animals and human renal biopsy samples. However, detecting early renal damage is a difficult task, since the routine renal function tests like creatine clearance, Insulin clearance (GFR) etc. are altered only after severe kidney damage. Recently increased urinary excretion of lysomal enzyme N-acetyl-B-D-glucosaminidase, a marker of early nephrotoxicity has been reported in the workers exposed to various chemicals including lead. The present study has therefore been undertaken to evaluate the subclinical lead toxicity on haemopoetic and renal system using non invassive techniques in monocasters, who are occupationally exposed to lead fumes while preparing the type set letter blocks. 23 refs., 3 figs.

  3. Performance of the new 2011 ACR/EULAR remission criteria with tocilizumab using the phase IIIb study TAMARA as an example and their comparison with traditional remission criteria.

    Science.gov (United States)

    Iking-Konert, Christof; Aringer, Martin; Wollenhaupt, Jürgen; Mosch, Thomas; Tuerk, Stefan; Feist, Eugen; Burmester, Gerd R

    2011-11-01

    Remission is the established goal in rheumatoid arthritis (RA) treatment. Although originally defined by a disease activity score in 28 joints (DAS28) EULAR remission criteria provide the newest and most stringent definition of remission. To evaluate post hoc the remission by ACR/EULAR criteria and compare the criteria with the conventional DAS28 in TAMARA, an open-label phase IIIb tocilizumab (TCZ) trial including patients with active RA receiving inadequate disease-modifying antirheumatic drugs (DMARDs) or tumour necrosis factor α (TNFα) inhibitor treatment. 286 patients were enrolled, 99.7% of patients were receiving a conventional DMARD and 41.6% had TNFα inhibitor pretreatment. Baseline mean DAS28 of 6.0 ± 1.0 fell to 2.6 ± 1.5 at week 24. DAS28 EULAR Boolean-based criteria for clinical studies were 15.0% after 12 weeks and 20.3% after 24 weeks. Of note, 13.5% of patients with previous TNFα blocker inadequate response still achieved remission according to the new ACR/EULAR criteria after 24 weeks. Clinical Disease Activity Index and Simplified Disease Activity Index remission rates were 24.1% and 25.2%, respectively. Under the definition of the new stringent 2011 ACR/EULAR remission criteria, patients with active RA despite DMARD treatment and even after inadequate response to TNFα inhibitors, receiving TCZ showed significant rates of remission. Similar remission rates were achieved, when clinical practice criteria, not inclusive of acute phase reactants, were used.

  4. 捏脊疗法治疗小儿哮喘非发作期临床观察%Clinical effects of chiropractic therapy on remission stage pediatric asthma

    Institute of Scientific and Technical Information of China (English)

    陈偶英; 李英; 钟捷; 帅云飞

    2013-01-01

    目的 观察捏脊疗法治疗小儿哮喘非发作期的临床疗效.方法 将68例哮喘非发作期小儿随机分为两组,治疗组34例给予捏脊疗法,2次/d;对照组34例给予口服酮替芬2次/d,30 d为1疗程,疗程结束后6个月对两组临床疗效进行观察.结果 治疗组总有效率为82.35%,明显优于对照组疗效总有效率58.82% (P<0.05),两组治疗后症状评分总和比较,治疗组治疗前、后症状评分总和比较,差异均具有统计学意义(P<0.05).结论 在小儿哮喘非发作期给予捏脊治疗对预防哮喘发作有积极影响,值得临床推广.%Objective To observe and evaluate the efficacy of chiropractic therapy on remission stage pediatric asthma.Methods 68 children with remission stage asthma were randomly divided into treatment group and control group with 34 in each group.Treatment group was treated with chiropractic therapy while control group was treated with oral ketotifen.The clinical effects of 2 groups were observed and compared after 6 months since the end of treatment.Results The total effective rate was 82.35% in treatment group,which was significantly higher than 58.82% in of control group (P<0.05).After treatment symptom score sum were different between 2 groups with statistic significances (P<0.05).In treatment group,the difference of symptom score sum was statistically significant before and after treatment (P<0.05).Conclusion Chiropractic therapy is effective for children with remission stage asthma.

  5. Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

    Directory of Open Access Journals (Sweden)

    Flint Alastair J

    2013-01-01

    Full Text Available Abstract Background Psychotic depression (PD is a severe disabling disorder with considerable morbidity and mortality. Electroconvulsive therapy and pharmacotherapy are each efficacious in the treatment of PD. Expert guidelines recommend the combination of antidepressant and antipsychotic medications in the acute pharmacologic treatment of PD. However, little is known about the continuation treatment of PD. Of particular concern, it is not known whether antipsychotic medication needs to be continued once an episode of PD responds to pharmacotherapy. This issue has profound clinical importance. On the one hand, the unnecessary continuation of antipsychotic medication exposes a patient to adverse effects, such as weight gain and metabolic disturbance. On the other hand, premature discontinuation of antipsychotic medication has the potential risk of early relapse of a severe disorder. Methods/design The primary goal of this multicenter randomized placebo-controlled trial is to assess the risks and benefits of continuing antipsychotic medication in persons with PD once the episode of depression has responded to treatment with an antidepressant and an antipsychotic. Secondary goals are to examine age and genetic polymorphisms as predictors or moderators of treatment variability, potentially leading to more personalized treatment of PD. Individuals aged 18-85 years with unipolar psychotic depression receive up to 12 weeks of open-label treatment with sertraline and olanzapine. Participants who achieve remission of psychosis and remission/near-remission of depressive symptoms continue with 8 weeks of open-label treatment to ensure stability of remission. Participants with stability of remission are then randomized to 36 weeks of double-blind treatment with either sertraline and olanzapine or sertraline and placebo. Relapse is the primary outcome. Metabolic changes are a secondary outcome. Discussion This trial will provide clinicians with much

  6. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

    OpenAIRE

    Bita Dadpour; Reza Afshari; Seyed Reza Mousavi; Sina Kianoush; Mohamad Reza Keramati; Vali Allah Moradi; Mahmood Sadeghi; Faezeh Madani Sani; Mahdi Balali Mood

    2016-01-01

    Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-ma...

  7. Lead

    Science.gov (United States)

    ... Chapter 6 Chapter 7 Chapter 8 Chapter 9 Appendix I Appendix II Tables Figures State Programs Alabama Alaska Arizona ... Tool Kit Resources Healthy Homes and Lead Poisoning Prevention Training Center (HHLPPTC) Training Tracks File Formats Help: ...

  8. 缓解期中轴型脊柱关节病患者亚临床炎症发生情况的分析%Presence of subclinical inflammation in axial spondyloarthropathy patients in clinical remission

    Institute of Scientific and Technical Information of China (English)

    吴颖; 徐胜前; 齐姗; 刘文; 蔡静; 徐建华

    2016-01-01

    ) exhibited bone marrow edema in sacroiliac joint (SPARCC > 0).27 patients (31.0%) were categorized as activity,while 23 patients (85.2%) exhibited bone marrow edema in sacroiliac joint (SPARCC > 0).According to ASDAScrp standard (n =75),12 patients (.16.0%) were classified as remission,of which 4 patients (33.3%) exhibited bone marrow edema in sacroiliac joint (SPARCC > 0).63 patients (31.0%) were categorized as activity,while 52 patients (82.5%) exhibited bone marrow edema in sacroiliac joint (SPARCC > 0).SPARCC score positively correlated with BASDAI (r =0.271,P < 0.05),ASDAScrp (r =0.291,P =0.011) and patient global assessment (r =0.414,P < 0.01).All the patients were classified as non-regular treatment group,traditional drugs group,and biologics group based on the therapeutic conditions.Percentages of patients with SPARCC > 0 in sacroiliac joint were also different among these groups (86.8%,75.0%,31.6%,x2 =21.483,P < 0.01).Conclusions About 1/3 to 2/3 axial SpA patients in clinical remission represent bone marrow edema in sacroiliac joint under MRI examination,which indicates presence of subclinical inflammation in axial SpA with clinical remission.SpA patients treated with biologics could have better remission of radiographic inflammation on MRI.

  9. Remission of rheumatoid arthritis and potential determinants: a national multi-center cross-sectional survey.

    Science.gov (United States)

    Wang, Guan-Ying; Zhang, Sa-Li; Wang, Xiu-Ru; Feng, Min; Li, Chun; An, Yuan; Li, Xiao-Feng; Wang, Li-Zhi; Wang, Cai-Hong; Wang, Yong-Fu; Yang, Rong; Yan, Hui-Ming; Wang, Guo-Chun; Lu, Xin; Liu, Xia; Zhu, Ping; Chen, Li-Na; Jin, Hong-Tao; Liu, Jin-Ting; Guo, Hui-Fang; Chen, Hai-Ying; Xie, Jian-Li; Wei, Ping; Wang, Jun-Xiang; Liu, Xiang-Yuan; Sun, Lin; Cui, Liu-Fu; Shu, Rong; Liu, Bai-Lu; Yu, Ping; Zhang, Zhuo-Li; Li, Guang-Tao; Li, Zhen-Bin; Yang, Jing; Li, Jun-Fang; Jia, Bin; Zhang, Feng-Xiao; Tao, Jie-Mei; Lin, Jin-Ying; Wei, Mei-Qiu; Liu, Xiao-Min; Ke, Dan; Hu, Shao-Xian; Ye, Cong; Han, Shu-Ling; Yang, Xiu-Yan; Li, Hao; Huang, Ci-Bo; Gao, Ming; Lai, Bei; Cheng, Yong-Jing; Li, Xing-Fu; Song, Li-Jun; Yu, Xiao-Xia; Wang, Ai-Xue; Wu, Li-Jun; Wang, Yan-Hua; He, Lan; Sun, Wen-Wen; Gong, Lu; Wang, Xiao-Yuan; Wang, Yi; Zhao, Yi; Li, Xiao-Xia; Wang, Yan; Zhang, Yan; Su, Yin; Zhang, Chun-Fang; Mu, Rong; Li, Zhan-Guo

    2015-02-01

    The aim of this study is to investigate the remission rate of rheumatoid arthritis (RA) in China and identify its potential determinants. A multi-center cross-sectional study was conducted from July 2009 to January 2012. Data were collected by face-to-face interviews of the rheumatology outpatients in 28 tertiary hospitals in China. The remission rates were calculated in 486 RA patients according to different definitions of remission: the Disease Activity Score in 28 joints (DAS28), the Simplified Disease Activity Index (SDAI), the Clinical Disease Activity Index (CDAI), and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definition. Potential determinants of RA remission were assessed by univariate and multivariate analyses. The remission rates of RA from this multi-center cohort were 8.6% (DAS28), 8.4% (SDAI), 8.2% (CDAI), and 6.8% (Boolean), respectively. Favorable factors associated with remission were: low Health Assessment Questionnaire (HAQ) score, absence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), and treatment of methotrexate (MTX) and hydroxychloroquine (HCQ). Younger age was also predictive for the DAS28 and the Boolean remission. Multivariate analyses revealed a low HAQ score, the absence of anti-CCP, and the treatment with HCQ as independent determinants of remission. The clinical remission rate of RA patients was low in China. A low HAQ score, the absence of anti-CCP, and HCQ were significant independent determinants for RA remission.

  10. Transposon leads to contamination of clinical pDNA vaccine.

    Science.gov (United States)

    van der Heijden, I; Gomez-Eerland, R; van den Berg, J H; Oosterhuis, K; Schumacher, T N; Haanen, J B A G; Beijnen, J H; Nuijen, B

    2013-07-11

    We report an unexpected contamination during clinical manufacture of a Human Papilomavirus (HPV) 16 E6 encoding plasmid DNA (pDNA) vaccine, with a transposon originating from the Escherichia coli DH5 host cell genome. During processing, presence of this transposable element, insertion sequence 2 (IS2) in the plasmid vector was not noticed until quality control of the bulk pDNA vaccine when results of restriction digestion, sequencing, and CGE analysis were clearly indicative for the presence of a contaminant. Due to the very low level of contamination, only an insert-specific PCR method was capable of tracing back the presence of the transposon in the source pDNA and master cell bank (MCB). Based on the presence of an uncontrolled contamination with unknown clinical relevance, the product was rejected for clinical use. In order to prevent costly rejection of clinical material, both in-process controls and quality control methods must be sensitive enough to detect such a contamination as early as possible, i.e. preferably during plasmid DNA source generation, MCB production and ultimately during upstream processing. However, as we have shown that contamination early in the process development pipeline (source pDNA, MCB) can be present below limits of detection of generally applied analytical methods, the introduction of "engineered" or transposon-free host cells seems the only 100% effective solution to avoid contamination with movable elements and should be considered when searching for a suitable host cell-vector combination.

  11. CASE OF LEFLUNOMIDE-INDUCED CLINICAL AND MORPHOLOGICAL REGRESSION OF AA-AMYLOIDOSIS AND REMISSION OF ADULT-ONSET STILL'S DISEASE

    Directory of Open Access Journals (Sweden)

    Yu. V. Muravyev

    2015-01-01

    Full Text Available The paper describes a long-term observation and discusses the possible mechanism of leflunomide-induced clinical and morphological regression of AA-amyloidosis diagnosed at a nephrotic stage in the presence of adult-onset Still's disease.

  12. From selection hits to clinical leads: progress in aptamer discovery

    Directory of Open Access Journals (Sweden)

    Keith E Maier

    2016-01-01

    Full Text Available Aptamers were discovered more than 25 years ago, yet only one has been approved by the US Food and Drug Administration to date. With some noteworthy advances in their chemical design and the enzymes we use to make them, aptamers and aptamer-based therapeutics have seen a resurgence in interest. New aptamer drugs are being approved for clinical evaluation, and it is certain that we will see increasingly more aptamers and aptamer-like drugs in the future. In this review, we will discuss the production of aptamers with an emphasis on the advances and modifications that enabled early aptamers to succeed in clinical trials as well as those that are likely to be important for future generations of these drugs.

  13. ontaneous Remission of Acromegaly Due to Apoplexy

    Directory of Open Access Journals (Sweden)

    Cevdet Duran

    2008-01-01

    Full Text Available Pituitary apoplexy is a rare clinical syndrome characterized by sudden onset of headache and vomiting, accompanied by visual disturbance or ocular motility impairment and pituitary insufficiency. Pituitary apoplexy presenting with these symptoms is seen in approximately 3% of patients with surgically treated pituitary adenomas. In acromegalic patients, apoplexy can be related to some provocating factors and rarely may be spontaneous. We present the case of an acromegalic patient with spontaneous remission after apoplexy. A 39-year-old male patient had transsphenoidal microsurgery for acromegaly in 1994 but remission was not achieved. After a 10-year period without follow-up, he experienced severe headache, nausea, vomiting, photophobia, and visual disturbance in July 2005 and scheduled an appointment with an ophthalmologist. His complaints ceased spontaneously within weeks. In October 2005, sellar MRI examination revealed a 3x2.5 cm mass of adenomatous tissue with necrosis. On admission to our clinic in November 2005, visual acuity, visual fields, and ocular motility, were normal; but results of laboratory tests revealed panhypopituitarism. He was thought to have apoplexy of a growth hormone secreting tumor, and hormone replacement therapy was initiated for panhypopituitarism. Because his symptoms had regressed, surgery was not considered. On rare occasions, acromegaly spontaneously remits after apoplexy, resulting in improved control of the functional adenoma without surgical intervention. Turk Jem 2008; 12: 80-2

  14. Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes

    OpenAIRE

    Adham Mottalib; Mahmoud Sakr; Mohamed Shehabeldin; Osama Hamdy

    2015-01-01

    Partial or complete remission from type 2 diabetes was recently observed after bariatric surgeries. Limited data is available about the possibility of inducing diabetes remission through intensive weight reduction. We retrospectively evaluated diabetes remissions after one year of the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week intensive program for diabetes weight management in real-world clinical practice. Among 120 obese patients with type 2 diabetes who comple...

  15. Pulmonary blastoma: remission with chemotherapy

    DEFF Research Database (Denmark)

    Nissen, Mogens Holst; Jacobsen, M; Vindeløv, L

    1984-01-01

    A 59-year-old man with pulmonary blastoma, who had undergone right-sided pneumonectomy, had a relapse of the tumour 7 months later. Light-microscopic and ultrastructural studies were consistent with recurrence from the primary tumour. Cell kinetic studies revealed a high fraction of tumour cells ...... in the S-phase. Complete remission of the recurrence was obtained within 16 days after initiation of combination chemotherapy consisting of CCNU, vincristine, VP-16 and cyclophosphamide....

  16. Clinical and Pathological Complete Remission in a Patient With Metastatic Renal Cell Carcinoma (mRCC Treated With Sunitinib: Is mRCC Curable With Targeted Therapy?

    Directory of Open Access Journals (Sweden)

    Amishi Y. Shah

    2015-03-01

    Full Text Available We report a patient with metastatic clear-cell renal cell carcinoma (mRCC who presented with primary tumor in situ in the left kidney and metastases to bone, liver, lungs, and brain. After over 5 years of sunitinib therapy and subsequent cytoreductive left nephrectomy, the patient achieved radiographic complete response (CR and had pathologic CR in the nephrectomy specimen. Durable clinical and pathological CRs are possible with targeted agents, even with primary tumor in situ and widely disseminated metastases. Ongoing research will define the optimal duration of systemic therapy in exceptional responders and identify the molecular determinants of response and resistance.

  17. Gene expression analysis of peripheral cells for subclassification of pediatric inflammatory bowel disease in remission.

    Directory of Open Access Journals (Sweden)

    Pieter P E van Lierop

    Full Text Available OBJECTIVE: In current clinical practice, optimal treatment of inflammatory bowel disease (IBD aims at the induction and maintenance of clinical remission. Clinical remission is apparent when laboratory markers of inflammation are normal and clinical symptoms are absent. However, sub-clinical inflammation can still be present. A detailed analysis of the immune status during this inactive state of disease may provide a useful tool to categorize patients with clinical remission into subsets with variable states of immune activation. DESIGN: By using Affymetrix GeneChips, we analysed RNA gene expression profiles of peripheral blood leukocytes from pediatric IBD patients in clinical remission and controls. We performed (unsupervised clustering analysis of IBD-associated genes and applied Ingenuity® pathway software to identify specific molecular profiles between patients. RESULTS: Pediatric IBD patients with disease in clinical remission display heterogeneously distributed gene expression profiles that are significantly distinct from controls. We identified three clusters of IBD patients, each displaying specific expression profiles of IBD-associated genes. CONCLUSION: The expression of immune- and IBD-associated genes in peripheral blood leukocytes from pediatric IBD patients in clinical remission was different from healthy controls, indicating that sub-clinical immune mechanisms are still active during remission. As such, RNA profiling of peripheral blood may allow for non-invasive patient subclassification and new perspectives in treatment regimes of IBD patients in the future.

  18. Psychological predictors of headache remission in children and adolescents

    Directory of Open Access Journals (Sweden)

    Carasco M

    2016-04-01

    Full Text Available Marcel Carasco, Birgit Kröner-Herwig Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institut für Psychologie, Georg-August-Universität Göttingen, Göttingen, Germany Objective: Longitudinal studies on headaches often focus on the identification of risk factors for headache occurrence or “chronification”. This study in particular examines psychological variables as potential predictors of headache remission in children and adolescents. Methods: Data on biological, social, and psychological variables were gathered by questionnaire as part of a large population-based study (N=5,474. Children aged 9 to 15 years who suffered from weekly headaches were selected for this study sample, N=509. A logistic regression analysis was conducted with remission as the dependent variable. In the first step sex, age, headache type, and parental headache history were entered as the control variables as some data already existed showing their predictive power. Psychological factors (dysfunctional coping strategies, internalizing symptoms, externalizing symptoms, anxiety sensitivity, somatosensory amplification were entered in the second step to evaluate their additional predictive value. Results: Highly dysfunctional coping strategies reduced the relative probability of headache remission. All other selected psychological variables reached no significance, ie, did not contribute additionally to the explanation of variance of the basic model containing sex and headache type. Surprisingly, parental headache and age were not predictive. The model explained only a small proportion of the variance regarding headache remission (R2=0.09 [Nagelkerke]. Conclusion: Successful coping with stress in general contributed to remission of pediatric headache after 2 years in children aged between 9 and 15 years. Psychological characteristics in general had only small predictive value. The issue of remission definitely needs more scientific attention

  19. An efficient protocol for the generation of monocyte derived dendritic cells using serum-free media for clinical applications in post remission AML patients.

    Science.gov (United States)

    da Silva Simoneti, Gisele; Saad, Sara Teresinha Olalla; Gilli, Simone Cristina Olenscki

    2014-01-01

    Protocols for the generation of dendritic cells (DCs) using serum as a supplementation of culture media leads to reactions due to animal proteins and disease transmissions. Several types of serum-free media (SFM), based on "good manufacture practices" (GMP), have recently been used and seem to be a viable option. The aim of this study was to evaluate the results of the differentiation, maturation, and function of DCs from Acute Myeloid Leukemia patients (AML), generated in SFM and medium supplemented with autologous serum (AS). DCs were analyzed by phenotype characteristics, viability, and functionality. The results showed the possibility of generating viable DCs in all the conditions tested. In patients, the X-VIVO 15 medium was more efficient than the other media tested in the generation of DCs producing IL-12p70 (p=0.05). Moreover, the presence of AS led to a significant increase of IL-10 by DCs as compared with CellGro (p=0.05) and X-Vivo15 (p=0.05) media, both in patients and donors. We concluded that SFM was efficient in the production of DCs for immunotherapy in AML patients. However, the use of AS appears to interfere with the functional capacity of the generated DCs.

  20. Prolonged remission maintenance in acute myeloid leukaemia.

    Science.gov (United States)

    Spiers, A S; Goldman, J M; Catovsky, D; Costello, C; Galton, D A; Pitcher, C S

    1977-08-27

    Twenty-five patients with acute myeloid leukaemia were treated with three quadruple drug combinations in predetermined rotation: TRAP (thioguanine, daunorubicin, cytarabine, prednisolone); COAP (cyclophosphamide, vincristine, cytarabine, prednisolone); and POMP (prednisolone, vincristine, methotrexate, mercaptopurine). Fifteen patients (60%) achieved complete remission and five (20%) partial remission. For maintenance, five-day courses of drugs were administered every 14 to 21 days and doses were increased to tolerance. The median length of complete remission was 66 weeks. In eight patients remission maintenance treatment was discontinued and some remained in complete remission for over two years. In this series the remission induction rate was comparable with that reported for other regimens and complete remission lasted longer with this intensive maintenance regimen than with others. Nevertheless, the TRAP programme must still be regarded as only palliative treatment for acute myeloid leukaemia.

  1. Evaluation of treatment response for breast cancer: are we entering the era of "biological complete remission"?

    Institute of Scientific and Technical Information of China (English)

    Li Bian; Tao Wang; Yi Liu; Hui-Qiang Zhang; Jin-Jie Song; Shao-Hua Zhang; Shi-Kai Wu; San-Tai Song; Ze-Fei Jiang

    2012-01-01

    Breast cancer is one of the most common malignancies in women.The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality.In this study,we tried to explore the role of circulating tumor cell (CTC) detection combination PET/CT technology evaluating the prognosis and treatment response of patients with breast cancer; meanwhile,we attempted to assess the concept of "biological complete remission" (bCR) in this regard.A 56-year-old patient with breast cancer (T2N1M1,stage Ⅳ left breast cancer,with metastasis to axillary lymph nodes and lungs) received 6 cycles of salvage treatment with albumin-bound paclitaxel plus capecitabine and trastuzumab.Then,she underwent CTC detection and PET/CT for efficacy evaluation.CTC detection combination PET/CT is useful for the evaluation of the biological efficacy of therapies for breast cancer.The bCR of the patient appeared earlier than the conventional clinical imaging complete remission and promised the histological (pathological) complete remission.The integrated application of the concepts including bCR,imageological CR,and histological CR can achieve the early and accurate assessment of biological therapeutic reponse and prognosis of breast cancer.

  2. ACR/EULAR Definitions of Remission Are Associated with Lower Residual Inflammatory Activity Compared with DAS28 Remission on Hand MRI in Rheumatoid Arthritis.

    Science.gov (United States)

    Lisbona, Maria Pilar; Solano, Albert; Ares, Jesús; Almirall, Miriam; Salman-Monte, Tarek Carlos; Maymó, Joan

    2016-09-01

    To determine the level of residual inflammation [synovitis, bone marrow edema (BME), tenosynovitis, and total inflammation] quantified by hand magnetic resonance imaging (h-MRI) in patients with rheumatoid arthritis (RA) in remission according to 3 different definitions of clinical remission, and to compare these remission definitions. A cross-sectional study. To assess the level of residual MRI inflammation in remission, cutoff levels associated to remission and median scores of MRI residual inflammatory lesions were calculated. Data from an MRI register of patients with RA who have various levels of disease activity were used. These were used for the analyses: synovitis, BME according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system, tenosynovitis, total inflammation, and disease activity composite measures recorded at the time of MRI. Receiver-operating characteristic analysis was used to identify the best cutoffs associated with remission for each inflammatory lesion on h-MRI. Median values of each inflammatory lesion for each definition of remission were also calculated. A total of 388 h-MRI sets of patients with RA with different levels of disease activity, 130 in remission, were included. Cutoff values associated with remission according to the Simplified Disease Activity Index (SDAI) ≤ 3.3 and the Boolean American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definitions for BME and tenosynovitis (1 and 3, respectively) were lower than BME and tenosynovitis (2 and 5, respectively) for the Disease Activity Score on 28 joints (DAS28) ≤ 2.6. Median scores for synovitis, BME, and total inflammation were also lower for the SDAI and Boolean ACR/EULAR remission criteria compared with DAS28. Patients with RA in remission according to the SDAI and Boolean ACR/EULAR definitions showed lower levels of MRI-detected residual inflammation compared with DAS28.

  3. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.

    Science.gov (United States)

    Weinfurtner, Kelley; Graves, Jennifer; Ness, Jayne; Krupp, Lauren; Milazzo, Maria; Waubant, Emmanuelle

    2015-09-01

    Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

  4. Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort.

    Science.gov (United States)

    Zhang, Bin; Combe, Bernard; Rincheval, Nathalie; Felson, David T

    2012-06-29

    In development of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) remission definitions using clinical trials data, one criterion used to compare different remission definitions was whether, compared with those not in remission, those in remission had evidence of later disease stability defined by x-ray and functional status. Validation of the RA remission criteria using observational study data is necessary before recommending their use in practice. Using data from those who met RA criteria in the ESPOIR cohort, we matched each person in remission with a person not in remission and then carried out analyses comparing later stability of x-ray and health assessment questionnaire (HAQ) between the two groups. We compared the predictive validity of the same candidate definitions of remission evaluated in the ACR/EULAR process. To minimize potential bias and produce more stable results, we used a bootstrap resampling approach to select those not in remission, repeating the sample matching analysis process 500 times. Results were similar to those of clinical trials analyzed for the ACR/EULAR remission criteria. Specifically, the ACR/EULAR remission definitions using either an simple disease activity index (SDAI) ≤ 3.3, clinical disease activity index (CDAI) ≤ 2.8 or a definition of remission requiring tender joint count, swollen joint count, patient global assessment all ≤ 1 performed as well or better than other candidate definitions of remission in terms of predicting later x-ray and function stability. ACR/EULAR definitions of remission developed for trials are similarly valid in observational studies in RA and could be used in practice.

  5. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

    National Research Council Canada - National Science Library

    Bita Dadpour; Reza Afshari; Seyed Reza Mousavi; Sina Kianoush; Mohamad Reza Keramati; Vali Allah Moradi; Mahmood Sadeghi; Faezeh Madani Sani; Mahdi Balali Mood

    2016-01-01

    .... This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods...

  6. Clinical Factors Associated with Long-Term Complete Remission versus Poor Response to Chemotherapy in HIV-Infected Children and Adolescents with Kaposi Sarcoma Receiving Bleomycin and Vincristine: A Retrospective Observational Study.

    Science.gov (United States)

    El-Mallawany, Nader Kim; Kamiyango, William; Slone, Jeremy S; Villiera, Jimmy; Kovarik, Carrie L; Cox, Carrie M; Dittmer, Dirk P; Ahmed, Saeed; Schutze, Gordon E; Scheurer, Michael E; Kazembe, Peter N; Mehta, Parth S

    2016-01-01

    Kaposi sarcoma (KS) is the most common HIV-associated malignancy in children and adolescents in Africa. Pediatric KS is distinct from adult disease. We evaluated the clinical characteristics associated with long-term outcomes. We performed a retrospective observational analysis of 70 HIV-infected children and adolescents with KS less than 18 years of age diagnosed between 8/2010 and 6/2013 in Lilongwe, Malawi. Local first-line treatment included bleomycin and vincristine plus nevirapine-based highly active anti-retroviral therapy (HAART). Median age was 8.6 years (range 1.7-17.9); there were 35 females (50%). Most common sites of presentation were: lymph node (74%), skin (59%), subcutaneous nodules (33%), oral (27%), woody edema (24%), and visceral (16%). Eighteen (26%) presented with lymphadenopathy only. Severe CD4 suppression occurred in 28%. At time of KS diagnosis, 49% were already on HAART. Overall, 28% presented with a platelet count < 100 x 109/L and 37% with hemoglobin < 8 g/dL. The 2-year event-free (EFS) and overall survival (OS) were 46% and 58% respectively (median follow-up 29 months, range 15-50). Multivariable analysis of risk of death and failure to achieve EFS demonstrated that visceral disease (odds ratios [OR] 19.08 and 11.61, 95% CI 2.22-163.90 and 1.60-83.95 respectively) and presenting with more than 20 skin/oral lesions (OR 9.57 and 22.90, 95% CI 1.01-90.99 and 1.00-524.13 respectively) were independent risk factors for both. Woody edema was associated with failure to achieve EFS (OR 7.80, 95% CI 1.84-33.08) but not death. Univariable analysis revealed that lymph node involvement was favorable for EFS (OR 0.28, 95% CI 0.08-0.99), while T1 TIS staging criteria, presence of cytopenias, and severe immune suppression were not associated with increased mortality. Long-term complete remission is achievable in pediatric KS, however outcomes vary according to clinical presentation. Based on clinical heterogeneity, treatment according to risk

  7. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

    Directory of Open Access Journals (Sweden)

    Bita Dadpour

    2016-02-01

    Full Text Available Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods: This cross sectional study was carried out in Mashhad, Iran, during April-June 2011. One hundred and twelve workers underwent blood and urine sampling for determination of lead concentrations and liver function tests. Clinical signs and symptoms of possible lead hepatotoxicity were investigated. Results: Mean (±SD age of the workers was 28.78 (±5.17 yr with a daytime work of 8.67 (±1.41 h and mean work duration of 3.89 (±2.40 yr. Mean blood lead concentration (BLC and urine lead concentration (ULC were 398.95 (±177.41 µg/l and 83.67(±50 μg/l, respectively. We found no correlation between the clinical findings and BLC or ULC. A weak correlation (R: 0.27, P=0.087 between serum alkaline phosphatase concentration and BLC was obtained. No significant relationship was found between other liver function tests and BLC or ULC. Conclusion: We found no specific clinical and laboratory abnormalities of liver in the workers of car battery manufacturer who had chronic lead toxicity. Further investigations with more specific laboratory tests such as LDH5 and gamma glutamyl transferase (GGT as well as novel biomarkers of metal induced hepatotoxicity might be helpful in evaluating lead hepatotoxicity.

  8. 御米油软胶囊干预痛风性关节炎缓解期的临床试验研究%Clinical Trial on the Effects of Yumi Oil Soft Capsules on Gouty Arthritis Remission

    Institute of Scientific and Technical Information of China (English)

    马方励; 徐强; 林昌松

    2011-01-01

    Objective: To evaluate the impact of Yumi oil soft capsules on gouty arthritis remission. Method: Using random comparison method ,50 cases of gouty arthritis patients were divided into test group and control group, respectively. The observation period was 8 weeks. Arthralgia indices, VAS score of overall disease condition, body weight, blood pressure, uric acid ( UA), erythrocyte sedimentation rate (ESR) and lipids ( triglyceride and total cholesterol) as the main efficacy indices,nocturia,urinary frequency,urinary urgency and dysuria as the minor efficacy indices,and blood tests,urine tests,stool check,liver function,kidney function and blood sugar level as the main security indices,the effect of Yumi oil soft capsules on gouty arthritis remission was studied. Result: Between the two groups,there was no statistical difference in the minor efficacy indices,while there was significant statistical difference in the other indices,especially in the joint pain and the blood level of UA,ESR and lipids. Conclusion: Under the premise of keeping the existing treatment programs of gouty arthritis patients, Yumi oil soft capsules can significantly improve the total score of clinical symptoms, tenderness and pain VAS score and reduce the uric acid and total cholesterol levels in serum,which enhance the overall efficacy of the treatment programs of gouty arthritis patients.%目的:评价御米油软胶囊对痛风性关节炎缓解期的干预作用.方法:采用随机对照方法,50例痛风性关节炎患者随机分为试验组和对照组,观察8周,疗效评价以关节痛指标、疾病总体状况的VAS评分、体质量、血压、血尿酸值(UA)、血沉(ESR)及血脂(三酰甘油、总胆固醇)为主要疗效指标,夜尿、尿频、尿急及尿痛为次要疗效指标;血尿常规、大便检查、肝肾功能及血糖等指标为主要安全性指标.结果:试验组与对照组除夜尿、尿频、尿急及尿痛次要疗效指标差异无统计学意义外,

  9. A framework for remission in SLE

    DEFF Research Database (Denmark)

    van Vollenhoven, Ronald; Voskuyl, Alexandre; Bertsias, George

    2017-01-01

    OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE....

  10. The role of Thymectomy in Remission of Myasthenia gravis patients with or without Thymoma

    Directory of Open Access Journals (Sweden)

    Manouchehr Aghajanzadeh

    2011-09-01

    Full Text Available Background: Myasthenia gravis is an auto immune disease thymus have important role in this disease which Thymoma is the primary tumor of thymus that is produced by augmentation of epithelial cells inside of Glands. Thymectomy can improved myasthenia gravis disease. The main aim of this study is to assess the remission among the myasthenic patients after thymectomy. Methods: From 1993 to 2004, 68 patients who underwent thymectomy for mysthenia gravis were studied. Myathenia was established by positive electromyography and tensilon tests. These patients were operated by one surgeon at teaching and private hospitals, the specimens were tested by pathologist and patients were under follow up for 12 to 48 months. In following- up time the patient’s answer to remedy was basis to daily use of Mestinone and myasthenia crisis was investigated. Results: The age of the patients was 14 to 60years. The average age of the patients who was 34/08 years old. In 42 of patients was female and 26 was men. Between the men, 11 had complete remission 14 partial remission and one no answer. Between the female, 21 had complete remission. 19 partial remission and 2 no answer. This study had no inhospital mortality, but in follow up we 4/4% mortality seen. In pathology studies, 21 patients had thymoma, 45 had hyperplasia, and 2 had normal thymus. In 21 patients with thymoma, 11 had complete remission, 10 partial remissions. Between 45 patients with hyperplasia, 20 complete remission, 22 partial remission and 3 no answer. From two normal pathology reports, 1 complete and one partial remission. Conclusion: We conclude that thymectomy is a beneficial procedure for myasthenia gravis patients with a complete clinical remission rate in our series. Therefore we conclude thymectomy for myasthenia gravis patients is indicated as early as possible in the course of disease.

  11. Mexican use of lead in the treatment of empacho: community, clinic, and longitudinal patterns.

    Science.gov (United States)

    Baer, R D; Garcia de Alba, J; Leal, R M; Plascencia Campos, A R; Goslin, N

    1998-11-01

    This paper discusses research designed to investigate community, clinic, and longitudinal patterns in use of lead as a treatment for empacho, a folk illness manifest by gastrointestinal symptoms. The same questionnaire used in a clinic-based study seven years previously in Guadalajara, Mexico, was used to interview a randomly selected community sample: in addition, the study was repeated at the same clinic sites that had been studied previously. The goals were to investigate: (1) What are community wide prevalences of empacho and use of lead based remedies? (2) To what extent are current patterns of use of lead for treatment of empacho in clinic-based samples similar to those seven years ago. The attributable risk to the population as a whole from use of lead based remedies was found to be 11% of the households of Guadalajara. Essentially this same estimate was seen for the 1987 and 1994 clinic populations. Interestingly, while percentages of lead users have declined since 1987, twice as great a percentage of informants reported treating empacho. Other patterns originally identified in 1987 persisted in 1994; lead use continues to be associated with lower levels of parental education and income.

  12. Symptomatic remission and patient quality of life in an observational study of schizophrenia: is there a relationship?

    Science.gov (United States)

    Haro, Josep M; Novick, Diego; Perrin, Elena; Bertsch, Jordan; Knapp, Martin

    2014-12-15

    This analysis aimed to examine the association between remission and quality of life (QOL) in schizophrenia. In post-hoc analyses of the 3-year, prospective, observational Schizophrenia Outpatients Health Outcomes (SOHO) study, we compared the QOL of patients who achieved symptomatic and clinical remission with those who did not, and the factors associated. Symptomatic remission was defined as achieving a score of ≤3 on the Clinical Global Impression-Schizophrenia (CGI-SCH) scale, maintained for 6 months and without hospitalization. QOL was patient self-rated using the European-QOL. Of the 6516 patients analyzed, 38% were in symptomatic remission 12 months post-baseline and 52% at 36 months. Functional remission remained fairly constant from 12 months to 36 months (22.4% at both time points). At all visits from 12 to 36 months, patient QOL and social functioning were significantly higher for patients in symptomatic remission. QOL was higher in patients in functional remission. Patients with maintained symptomatic remission over the 3-year follow-up had a much greater improvement in QOL than patients with no symptomatic remission or symptomatic remission for part of the period. Factors associated with a better QOL also included paid employment, socially active, a higher CGI-SCH cognitive score, good compliance, and a better baseline QOL. Copyright © 2014. Published by Elsevier Ireland Ltd.

  13. Ulcerative Colitis Remission Status After Induction With Mesalazine Predicts Maintenance Outcomes: the MOMENTUM Trial

    Science.gov (United States)

    Rubin, David T.; Bradette, Marc; Gabalec, Libor; Dobru, Daniela; Márquez, Juan; Inglis, Susi; Magee, Elizabeth; Solomon, Dory

    2016-01-01

    Background and Aims: This study assessed the efficacy of maintenance treatment with multimatrix mesalazine following achievement of complete or partial remission after induction treatment with high-dose multimatrix mesalazine. Methods: In this phase 3b/4, open-label, multicentre, prospective, single-arm study, patients with mild-to-moderate ulcerative colitis were treated with multimatrix mesalazine 4.8g/day once daily for 8 weeks [induction phase]. At Week 8, those who achieved complete or partial remission, based on predefined clinical and endoscopic criteria, were eligible to receive 12 months of multimatrix mesalazine 2.4g/day once daily maintenance therapy. The primary endpoint was the proportion of patients in complete remission at Month 12. Results: A total of 717 patients received induction treatment; 25.9% and 39.3% of patients achieved complete and partial remission, respectively, at Week 8. A total of 461 patients entered the maintenance phase. The likelihood of remaining in/achieving complete remission at Month 12 was higher for patients who entered the maintenance phase in complete remission compared with those who began maintenance in partial remission [47.8% vs 26.0%; p < 0.001]. At Month 12, mucosal healing [endoscopy score ≤ 1] was demonstrated in 76.4% [139/182] and 63.5% [176/277] of those who were in complete and partial remission, respectively, at the end of induction. Conclusion: Patients achieving complete remission before dose reduction were more likely to remain in remission at Month 12. PMID:26908939

  14. Association between right ventricular lead position and clinical outcomes in patients with cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Kronborg, Mads Brix; Johansen, Jens Brock; Riahi, Sam

    2017-01-01

    Aims: To evaluate the association between an apical vs. non-apical right ventricular lead position (RV-LP) and clinical outcome in a large nationwide cohort of patients treated with cardiac resynchronization therapy (CRT). Methods and results: We included consecutive Danish patients receiving a CRT...

  15. Vectorcardiographic diagnostic & prognostic information derived from the 12-lead electrocardiogram: Historical review and clinical perspective.

    Science.gov (United States)

    Man, Sumche; Maan, Arie C; Schalij, Martin J; Swenne, Cees A

    2015-01-01

    In the course of time, electrocardiography has assumed several modalities with varying electrode numbers, electrode positions and lead systems. 12-lead electrocardiography and 3-lead vectorcardiography have become particularly popular. These modalities developed in parallel through the mid-twentieth century. In the same time interval, the physical concepts underlying electrocardiography were defined and worked out. In particular, the vector concept (heart vector, lead vector, volume conductor) appeared to be essential to understanding the manifestations of electrical heart activity, both in the 12-lead electrocardiogram (ECG) and in the 3-lead vectorcardiogram (VCG). Not universally appreciated in the clinic, the vectorcardiogram, and with it the vector concept, went out of use. A revival of vectorcardiography started in the 90's, when VCGs were mathematically synthesized from standard 12-lead ECGs. This facilitated combined electrocardiography and vectorcardiography without the need for a special recording system. This paper gives an overview of these historical developments, elaborates on the vector concept and seeks to define where VCG analysis/interpretation can add diagnostic/prognostic value to conventional 12-lead ECG analysis.

  16. [Management Competence in Leading Positions in Clinical Surgery - What Does a Surgeon Need to Know?

    Science.gov (United States)

    Hellmann, W; Meyer, F

    2016-12-01

    Background: Surgeons, more than other specialists, are required to combine high medical expertise with management competence. This is due to changing environments, new demands with respect to quality, the ongoing discussion on increased performance in the context of questionable target agreements, an increasing tendency of university hospitals and other departments and clinics to recruit leading personnel in medicine with management competence, but also to the understanding of one's own role and surgeons' distinguished public reputation. Aim: This narrative review describes the changing environments for surgeons in leading positions in hospitals and provides an overview on the practical use of management skills in surgery. In addition, it advises on how to acquire management competence and presents an educational concept appropriate for surgeons in leading positions. Key points: 1. The management of new challenges in the healthcare system - also in clinical surgery - requires management skills, which are indispensable for a surgeon in a leading position. 2. Management skills in surgery comprise aspects such as communication ability, social competence, cooperation and leadership skills, knowledge on business administration aspects and legal certainty. 3. The necessary knowledge can be acquired in courses leading to a certificate (e.g. "MHM® Medical Hospital Manager") or by earning a "Master of Business Administration" (MBA). Conclusion: Management competence is essential in leading positions in clinical surgery today. The use of these skills is challenging in daily practice. Successfully applied, management competence not only guarantees comprehensive patient care and leadership of employees, but also provides satisfaction in leading positions of a surgical department. Georg Thieme Verlag KG Stuttgart · New York.

  17. Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease

    OpenAIRE

    Emma Wikholm MD; Petter Malmborg MD, PhD; Maria Forssberg MD; Carl-Axel Hederos MD, PhD; Sverre Wikström MD, PhD

    2016-01-01

    The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, ...

  18. Predictive Factors of Type 2 Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis

    OpenAIRE

    Wang, Guo-Feng; Yan, Yong-Xin; Xu, Ning; Yin, Dong; Hui, Yuan; Zhang, Ji-Ping; Han, Guan-Jun; MA, Ning; Wu, Yan; Xu, Jing-Zi; YANG, Tao

    2014-01-01

    Background Although a few studies have been reported on predictive factors of postoperative diabetes remission, the conclusions remain inconsistent. This meta-analysis aimed to assess the preoperative clinical factors for type 2 diabetes mellitus (T2DM) remission after bariatric surgery. Methods The Cochrane Library, PubMed, MEDLINE, Embase, and CINAHL databases were searched. All human studies published in English between 1 January 1992 and 1 September 2013 reporting on the parameters of int...

  19. Remission and Recovery in the Treatment for Adolescents with Depression Study (TADS): Acute and Long-Term Outcomes

    Science.gov (United States)

    Kennard, Betsy D.; Silva, Susan G.; Tonev, Simon; Rohde, Paul; Hughes, Jennifer L.; Vitiello, Benedetto; Kratochvil, Christopher J.; Curry, John F.; Emslie, Graham J.; Reinecke, Mark; March, John

    2009-01-01

    The remission and recovery rates of adolescent patients with depression who were treated with fluoxetine, cognitive-behavioral therapy, their combination, and placebos were examined through a multisite clinical trial. It is concluded that most depressed adolescents who received such therapies achieved remission at the end of nine months.

  20. Crohn's disease genotypes of patients in remission vs relapses after infliximab discontinuation

    Institute of Scientific and Technical Information of China (English)

    Cathy Lu; Alistair Waugh; Robert J Bailey; Raeleen Cherry; Levinus A Dieleman; Leah Gramlich; Kata Matic

    2012-01-01

    AIM:To investigate genetic differences between Crohn's disease (CD) patients with a sustained remission vs relapsers after discontinuing infliximab while in corticosteroid-free remission.METHODS:Forty-eight CD patients received infliximab and were in full corticosteroid-free clinical remission but then discontinued infliximab for reasons other than a loss of response,were identified by review of an electronic database and charts.Infliximab-associated remission was defined as corticosteroid-free plus normalization of clinical disease activity [CD activity index (CDAI)< 150] during follow-up visits based on physician global assessments.A CD relapse (loss of infliximab-induced remission) was clinically defined as a physician visit for symptoms of disease activity (CDAI > 220) and a therapeutic intervention with CD medication(s),or a hospitalization with complications related to active CD.Genetic analyses were performed on samples from 14 patients (n =6 who had a sustained long term remission after stopping infliximab,n =8 who rapidly relapsed after stopping infliximab).Nucleotide-binding oligomerization domain 2 (NOD2)/caspase activation recruitment domain 15 (CARD15) polymorphisms (R702W,G908R and L1007fs) and the inflammatory bowel disease 5 (IBD5)polymorphisms (IGR2060a1 and IGR3081a1) were analyzed in each group.RESULTS:Five single nucleotide polymorphisms of IBD5 and NOD2/CARD15 genes were successfully analyzed for all 14 subjects.There was no significant increase in frequency of the NOD2/CARD15 polymorphisms (R702W,G908R and L1007fs) and the IBD5 polymorphisms (IGR2060a1 and IGR3081a1) in either group of patients; those whose disease relapsed rapidly or those who remained in sustained long term remission following the discontinuation of infliximab.Nearly a third of patients in full clinical remission who stopped infliximab for reasons other than loss of response remained in sustained clinical remission,while two-thirds relapsed rapidly.There was a marked

  1. [Chronic lead poisoning like a group pathology. Clinical report of 12 cases].

    Science.gov (United States)

    Mihalache, Cornelia; Oprea, Veronica; Constantin, Brânduşa; Pintilie, Wanda; Teslariu, Elena; Pal, Cristina

    2004-01-01

    The objective of this article is to present a series of 12 cases with the chronic lead poisoning produced after a short but intensive professional exposure (in average 12-14 hours per day, 41.6 days) at mineral dust and oxides containing lead (technical revision of a oven and of a furnace network by mechanical and welding operation). After the first case with saturnine colic, all the workers of the same team (n=12) were hospitalised (average time was of 14 days) with clinical examination and by specific toxicological indicators. Particularly, for clinical picture were uncharacteristic and oligosymptomatic complaints. Occupational exposure was augmented by the level of Pb-blood (46.8-286 mg/100 ml are ranges), Pb-urine (221-637 mg/l are ranges), d-aminolevulinic urinary acid (22.9-99.1 mg/l are ranges) and increased urinary coproporphyrins (+ +, + + +) exceeding biological limits and high urinary discharge of lead induced by CaNa2-EDTA treatment. The biological effects of lead intoxication consist in the occurrence of stippled basophilic erythrocytes (2 cases with 46,000/1 mil erythrocytes), the anemia (only 4 cases with haematocrit L 40%) and the liver cytolytic syndrome (the increase of GPT, GOT and of g-GT). These changes and the polyneuropathic syndrome (the decrease of motor and sensitive speed velocity) were judged by toxic combination between ethanol and lead.

  2. Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

    Science.gov (United States)

    Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

    2013-01-01

    To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.

  3. Posaconazole for primary antifungal prophylaxis in patients with acute myeloid leukaemia or myelodysplastic syndrome during remission induction chemotherapy: a single-centre retrospective study in Korea and clinical considerations.

    Science.gov (United States)

    Cho, Sung-Yeon; Lee, Dong-Gun; Choi, Su-Mi; Choi, Jae-Ki; Lee, Hyo-Jin; Kim, Si-Hyun; Park, Sun Hee; Choi, Jung-Hyun; Yoo, Jin-Hong; Kim, Yoo-Jin; Kim, Hee-Je; Min, Woo-Sung

    2015-09-01

    Posaconazole was introduced as the primary antifungal prophylaxis (PAP) in acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) patients during remission induction chemotherapy. Data on breakthrough invasive fungal infections (IFIs) from various centres are essential, as there are several considerations in treating IFIs in the posaconazole era. The aim of this study was to evaluate the effectiveness of posaconazole PAP and identify characteristics of IFIs at a single centre in Korea. We retrospectively reviewed consecutive patients with AML/MDS undergoing remission induction chemotherapy between December 2010 and November 2013. Of the 424 patients, 140 received posaconazole and 284 received fluconazole prophylaxis. The incidence of breakthrough proven/probable IFIs (15.5% vs. 2.9%, P posaconazole group compared to the fluconazole group. In the posaconazole PAP group, two cases of breakthrough mucormycosis were noted among 13 proven/probable/possible IFI cases (15.4%). Overall and IFI-related mortality was 12.1% and 1.9% respectively. Fungus-free survival was significantly higher in the posaconazole group (74.7% vs. 87.1%, P = 0.028). Breakthrough IFIs and EAFT decreased significantly after posaconazole PAP. The benefit in fungus-free survival was noted with posaconazole PAP. Clinicians should be vigilant to identify non-Aspergillus IFIs with active diagnostic effort.

  4. 冬病夏治穴位敷贴疗法治疗小儿哮喘缓解期100例临床观察%Clinical observation of acu-point application therapy in treating children remission stage asthma following “treating winter-diseases in summer” principle

    Institute of Scientific and Technical Information of China (English)

    高维银; 任辉杰

    2012-01-01

    Objective To observe and evaluate the efficacy of acu-point application on pedi-atric remission stage asthma following "treating winter-diseases in summer" principle. Methods In the summer of 2009 and 2010,the therapy of acu-point application were applied on 100 children with remission stage asthma. The asthma attacks,emergency clinic visits,hospitalizations were observed for one year after treatment. Results The asthma attacks,emergency clinic visits,hospitalizations were decreased significantly than those before treatment; the statistic differences were significant (P<0.01). Conclusion Acu-point application therapy in summer was effective for children with remission stage asthma.%目的 观察冬病夏治穴位敷贴疗法对小儿哮喘缓解期的临床疗效.方法 对2009~2010年儿科运用冬病夏治穴位敷贴治疗小儿哮喘缓解期的100例并进行随访观察,从发作次数、急诊次数、住院次数等方面进行比较.结果 1年内惠儿哮喘发作次数、急诊就诊次数、住院次数均较治疗前明显减少,差异有统计学意义(P<0.01).结论 冬病夏治穴位敷贴疗法对于小儿哮喘缓解期具有较好的临床疗效.

  5. Clinical Efficacy of Dog-days Acupoint Application in the Treatment of Remission Phase of Chronic Obstructive Pulmonary Disease%冬病夏治三伏贴治疗慢性阻塞性肺疾病缓解期临床疗效研究

    Institute of Scientific and Technical Information of China (English)

    郭良斌; 江永琴; 石丽莉

    2016-01-01

    目的:探讨冬病夏治三伏贴治疗慢性阻塞性肺疾病缓解期临床疗效。方法48例慢性阻塞性肺疾病缓解期患者根据随机数字表法分为研究组和对照组,每组24例,对照组患者给予化痰、止咳、平喘等常规治疗,研究组在对照组的基础上采用平喘止咳贴进行治疗。结果研究组治疗总有效率,治疗后FVC、FEV1高于对照组(P<0.05)。结论对于慢性阻塞性肺疾病缓解期患者采用冬病夏治三伏贴进行治疗,临床疗效显著,能有效改善肺功能。%Objective To explore the clinical efficacy of dog-days acupoint application in the treatment of remission phase of chronic obstructive pulmonary disease (COPD).Methods 48 cases of COPD remission phase were randomly divided into study group and control group, 24 patients each. Control group were given eliminating phlegm, relieving cough, relieving asthma and other conventional treatment, study group used Pingchuanzhike plaster on the basis of control group. Results The total efficiency, FVC and FEV1 of study group after treatment were signiifcantly higher than control group (P<0.05). Conclusion For COPD patients in remission phase, the treatment with dog-days acupoint application from curing winter disease in summer, has signiifcant clinical effect and can effectively improve lung function.

  6. Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

    Directory of Open Access Journals (Sweden)

    Cristina Alvarez-Escola

    2016-11-01

    Full Text Available In patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH and insulin-like growth factor (IGF1 levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status. The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission.

  7. Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

    Science.gov (United States)

    Cardenas-Salas, Jersy

    2016-01-01

    Summary In patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH) and insulin-like growth factor (IGF1) levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status). The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission. Learning points: The probability of disease recurrence is high after discontinuation of treatment with somatostatin analogues. Current data indicate that remission after treatment discontinuation may be more likely in patients with low GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on MRI, and/or in patients receiving prolonged treatment. This case report suggests that prolonged treatment with somatostatin analogues can be curative in carefully selected patients. PMID:27933171

  8. Paternal alcoholism predicts the occurrence but not the remission of alcoholic drinking

    DEFF Research Database (Denmark)

    Knop, J; Penick, E C; Nickel, E J

    2007-01-01

    OBJECTIVE: To test the effects of father's alcoholism on the development and remission from alcoholic drinking by age 40. METHOD: Subjects were selected from a Danish birth cohort that included 223 sons of alcoholic fathers (high risk; HR) and 106 matched controls (low risk; LR). Clinical...... examinations were performed at age 40 (n = 202) by a psychiatrist using structured interviews and DSM-III-R diagnostic criteria. RESULTS: HR subjects were significantly more likely than LR subjects to develop alcohol dependence (31% vs. 16%), but not alcohol abuse (17% vs. 15%). More subjects with alcohol...... abuse were in remission at age 40 than subjects with alcohol dependence. Risk did not predict remission from either alcohol abuse or alcohol dependence. CONCLUSION: Familial influences may play a stronger role in the development of alcoholism than in the remission or recovery from alcoholism....

  9. Rates and predictors of remission, recurrence and conversion to bipolar disorder after the first lifetime episode of depression

    DEFF Research Database (Denmark)

    Bukh, J. D.; Andersen, P. K.; Kessing, L. V.

    2016-01-01

    to 2013. Cumulative incidences and the influence of clinical variables on the rates of remission, recurrence and conversion to bipolar disorder, respectively, were estimated by survival analysis techniques. RESULTS: Within 5 years, 83.3% obtained remission, 31.5% experienced recurrence of depression and 8......BACKGROUND: In depression, non-remission, recurrence of depressive episodes after remission and conversion to bipolar disorder are crucial determinants of poor outcome. The present study aimed to determine the cumulative incidences and clinical predictors of these long-term outcomes after the first.......6% converted to bipolar disorder (6.3% within the first 2 years). Non-remission increased with younger age, co-morbid anxiety and suicidal ideations. Recurrence increased with severity and treatment resistance of the first depression, and conversion to bipolar disorder with treatment resistance, a family...

  10. Clinical analysis of 12 cases with congenital hyperinsulinism with spontaneous remission%自行缓解的先天性高胰岛素血症12例临床分析

    Institute of Scientific and Technical Information of China (English)

    徐子迪; 吴玉筠; 桑艳梅; 闫洁; 刘敏; 梁学军; 张亚南; 张微

    2015-01-01

    目的对12例自行缓解的先天性高胰岛素血症(CHI)患儿的临床特征及随访资料进行回顾性分析,以期为CHI患儿治疗提供理论依据。方法选取2008年12月至2014年1月间首都医科大学附属北京儿童医院收治且自行缓解的12例CHI患儿为研究对象,对患儿的临床资料及后期随访数据进行分析。结果12例患儿的血糖不需要药物治疗,或者是停用药物后即可维持正常血糖至少3个月,提示该组为自行缓解的CHI患儿。其中4例患儿未服用任何药物仅需加强喂养即可自行缓解,另8例患儿均接受了二氮嗪治疗后逐渐减停药物后获得缓解,其中5例有效,3例无效;8例患儿中有1例患儿同时接受了二氮嗪及奥曲肽治疗,且均有效。12例患儿起病年龄均在1岁以内,且多于6个月以内起病(10/12),多为足月适于胎龄儿(7/12),另有巨大儿4例,足月小于胎龄儿1例。12例患儿中,有7例(7/12)于1岁以内低血糖症状缓解,最晚缓解年龄为6岁,其中有4例患儿检测出携带ABCC8基因突变。结论部分CHI患儿有自行缓解的趋势,应延长患儿的随访年龄,对二氮嗪治疗无效的CHI患儿应谨慎选择手术治疗,从而最大限度地避免术后并发症的发生。%Objective To provide a more reasonable therapeutic schedule for congenital hyperinsulinism (CHI) children and to analyze the clinical characteristics and follow-up data of the 12 cases with CHI whose symptoms alleviated spontaneously. Methods We choosed 12 patients with CHI whose symptoms alleviated spontaneously, hospitalized in Beijing Children′s Hospital from December 2008 to January 2014,as research subjects. The clinical data and post follow-up data were analyzed retrospectively. Results The 12 patients can maintain normal blood glucose for at least three months without drug treatment or after stopping the drug, which suggest that the group of children with

  11. Spontaneous, drug-induced, and drug-free remission in peripheral and axial spondyloarthritis.

    Science.gov (United States)

    Poddubnyy, Denis; Gensler, Lianne S

    2014-10-01

    In spondyloarthritis (SpA), spontaneous remission is best described in reactive arthritis, a form of peripheral SpA. Prior SpA observational studies suggested that a significant percentage of patients reached spontaneous remission; however, these patients were followed up under older, broader European Spondyloarthropathy Study Group (ESSG) criteria or were not defined by specific criteria. In general, they were mixed populations of peripheral and axial disease, and the subsets were not differentiated when assessing end points such as remission. There are limited data on the natural history of axial SpA, in part because of the evolution of the criteria with the more recently developed Assessment of SpondyloArthritis International Society (ASAS) criteria, including the designation of non-radiographic axial SpA and peripheral SpA. Clinical trials have been conducted with various remission end points including withdrawal of therapy to determine remission maintenance. The following review addresses the potential for remission in axial and peripheral SpA based on the data from both observational studies and clinical trials.

  12. Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma

    Institute of Scientific and Technical Information of China (English)

    WANG Xian-ling; DOU Jing-tao; L(U) Zhao-hui; ZHONG Wen-wen; BA Jian-ming; JIN Du; LU Ju-ming; PAN Chang-yu; MU Yi-ming

    2011-01-01

    Background Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion.The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly.We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma.Methods Six patients with spontaneous remission of acromegaly or gigantism were enrolled.The clinical characteristics,endocrinological evaluation and imageological characteristics were retrospectively analyzed.Results In these cases,the initial clinical presences were diabetes mellitus or hypogonadism.No abrupt headache,vomiting,visual function impairment,or conscious disturbance had ever been complained of.The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher,but nadir GH levels were all still >1 μg/L in 75 g oral glucose tolerance test.Magnetic resonance imaging detected enlarged sella,partial empty sella and compressed pituitary.The transsphenoidal surgery was performed in 2 cases,and the other patients were conservatively managed.All the patients were in clinical remission.Conclusions When the clinical presences,endocrine evaluation,biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly,the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed.To these patients,conservative therapy may be appropriate.

  13. Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma.

    Science.gov (United States)

    Wang, Xian-Ling; Dou, Jing-Tao; Lü, Zhao-Hui; Zhong, Wen-Wen; Ba, Jian-Ming; Jin, Du; Lu, Ju-Ming; Pan, Chang-Yu; Mu, Yi-Ming

    2011-11-01

    Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma. Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed. In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher, but nadir GH levels were all still > 1 µg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission. When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.

  14. Clinical Observation on the Effect of Kidney and Blood Detoxification in Treatment of Patients with Gout at the Remission Stage%滋肾补血解毒合剂对缓解期痛风患者治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    王艳

    2009-01-01

    Objective To observe the Clinical effect of kidney and blood detoxification in treatment of patients with gout at the remission stage. Methods 51 cases of patients with gout at remission were randomly divided into two groups, with treatment group 26 cases using blood detoxifieation nourishing the kid-hey treatment, 25 cases of the control group under the condition of oral probenecid, benzbromarone and sodium bicarbonate treatment, to compare the clinical in-dicators, efficacy and safety of the two groups after treatment. Results The total effective rate was 92.3% in the treatment group, while the total effective rate was 80.0% in the control group. There was no significant difference between the total effective rates (P >0.05); there was no significant difference in comparison of serum uric acid before and after treatment between the two groups(P >0.05); but there was more significant difference in comparison of serum uric acid before and after treatment in each group(P 0.05.两组治疗前后血尿酸组间比较无显著差异,P>0.05;两组治疗前后血尿酸组内比较有极显著差异,P<0.01.结论 滋肾补血解毒合剂治疗缓解期痛风的疗效可靠,且无不良反应.

  15. Remission and regression of diabetic nephropathy

    DEFF Research Database (Denmark)

    Hovind, Peter; Tarnow, Lise; Parving, Hans-Henrik

    2004-01-01

    diabetic patients with overt nephropathy, remission (decrease in albuminuria to diabetic nephropathy (rate of decline in GFR treatment. Furthermore, remission of nephrotic-range albuminuria......Diabetic kidney disease is considered to be an irreversible and inexorable progressive disease. Therefore, prevention of development of ESRD is extremely important. Animal studies have demonstrated that regression of existing renal morphologic lesions is feasible. In a sizable fraction of type 1...... in diabetic patients, an aggressive multifactorial approach, aiming at lowering blood pressure and albuminuria, and improving glycemic control, must be applied....

  16. Fedmekirurgi er mere effektiv end medicinsk behandling til opnåelse af remission af type 2-diabetes

    DEFF Research Database (Denmark)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-01-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly...

  17. Remission induction and remission maintenance in adult acute nonlymphocytic leukemia employing a modified cytostatic (COAP) regimen.

    Science.gov (United States)

    Gerecke, D; Hirschmann, W D; Voigtmann, R; Gross, R

    1979-07-01

    Thirty adult patients suffering from acute nonlymphocytic leukemia (ANLL) were treated according to a modified COAP regimen. Vincristine, cyclophosphamide, and prednisone were given by push injection, while cytosine arabinoside was infused over periods of 8 h. Nineteen patients (63%) achieved complete remission. Remission maintenance therapy consisted of 6-mercaptopurine daily and methotrexate twice weekly. Later in the study, COAP consolidation and reinduction was added, which improved the median duration of complete remission from 7 to 24 months. Comparison of the results with the literature shows that the modified COAP regimen is one of the most effective treatment schedules for adult ANLL.

  18. Remission of eating disorder during pregnancy

    DEFF Research Database (Denmark)

    Madsen, Ida Ringsborg; Hørder, Kirsten; Støving, René Klinkby

    2009-01-01

    Eating disorder during pregnancy is associated with a diversity of adverse outcomes and is of potential danger to both mother and child. There is, however, a tendency for remission of the eating disorder during pregnancy with improvement of symptoms such as restrictive dieting, binging and purgin...

  19. Clinical observation of HAG regimen in remission inductive treatment for elderly patients with acute myeloid leukemia and myelodysplastic syndrome%HAG预激化疗作为诱导缓解方案治疗老年人急性髓系白血病和骨髓增生异常综合征的临床观察

    Institute of Scientific and Technical Information of China (English)

    王剑利; 何爱丽; 张王刚; 杨云; 古流芳; 孔颖

    2011-01-01

    Objective To observe the efficacy of HAG regimen in remission inductive treatment for elderly patients with acute myeloid leukemia (AML) and myelodysplastic syndrome-refractory anemia with excess blasts (MDS-RAEB). Methods The clinical features of 21 cases with AML and 9 cases with MDSRAEB (≥60 year old) treated with HA-G regimen in remission induction were retrospectively analyzed,including the complete remission (CR) rate, efficiency rate as well as their toxicities. Results In 21 elderly patients with AML treated with HAG regimen, the efficiency rate was 66.7 % (14/21), CR rate 47.6 % (10/21).In 9 elderly patients with MDS-RAEB, the CR rate was 55.6 % (5/9). The main toxicity of HA-G regimen was infections secondary to hematopoiesis suppression after chemotherapy. All patients were well tolerated to adjusted regimen. Conclusion The HA-G regimen is much effective in remission induction for elderly patients with AML and MDS-RAEB.%目的 观察HAG预激化疗作为诱导缓解方案在治疗老年急性髓系白血病(AML)和骨髓增生异常综合征-难治性贫血伴原始细胞增多型(MDS-RAEB)患者中的疗效.方法 对应用HAG预激方案治疗的21例AML和9例MDS-RAEB患者(≥60岁)的临床资料进行回顾性总结,包括疾病完全缓解(CR)率、有效率以及不良反应.结果 21例老年AML患者中,HAG诱导缓解的有效率为66.7%(14/21),其中CR率为47.6%(10/21);9例老年MDS-RAEB患者中,CR率为55.6%(5/9):HAG预激化疗的主要不良反应为因骨髓抑制继发的感染,调整化疗方案后所有患者均能耐受.结论 HAG预激化疗作为诱导缓解方案适用于老年AML和MDS-RAEB患者.

  20. Comparison between Clinically Used Irregular Fields Shielded by Cerrobend and Standard Lead Blocks

    Directory of Open Access Journals (Sweden)

    Farajollahi A. R.

    2015-06-01

    Full Text Available Introduction: In radiation therapy centers across Iran, protection of normal tissues is usually accomplished by either Cerrobend or lead block shielding. In this study, the influence of these two shielding methods on central axis dose distribution of photon beam a Cobalt unit was investigated in clinical conditions. Materials and Methods: All measurements were performed for 60Co γ-ray beams and the Cerrobend blocks were fabricated by commercial Cerrobend materials. Standard lead block shields belonged to Cobalt unit. Data was collected through a calibrated ionization chamber, relative dosimetry systems and a TLD dosimetery. Results: Results of the percent depth dose (PDD measurements at depths of 0.5, 1, 5, 10, 15 and 20 cm for 23 different field sizes of patients with head and neck cancer showed no significant differences between lead and Cerrobend shielding methods. Measurement results of absolute dosimetry in depths of 1.5, 3, 5, 7, 10 and 12 cm also showed no significant differences between these two shielding methods. The same results were obtained by TLD dosimetry on patient skin. Conclusion: Use of melt shielding methods is a very easy and fast shield-making technique with no differences in PDD, absolute and skin dose between lead and Cerrobend block shielding methods.

  1. Poor R wave progression in the precordial leads: clinical implications for the diagnosis of myocardial infarction.

    Science.gov (United States)

    DePace, N L; Colby, J; Hakki, A H; Manno, B; Horowitz, L N; Iskandrian, A S

    1983-12-01

    A definite diagnosis of anterior myocardial infarction is often difficult to make in patients when a pattern of poor R wave progression in the precordial leads is present on the electrocardiogram. The purpose of this study was to determine whether a mathematical model could be devised to identify patients with anterior infarction among 102 consecutive patients with poor R wave progression. Each patient underwent exercise testing with thallium scanning. The diagnosis of anterior infarction was established in 20 (20%) of the 102 patients by the presence of fixed thallium-201 perfusion defects in the anterior wall or septum, or both. With the use of a multivariate stepwise discriminant analysis of clinical and electrocardiographic variables, five variables (sex, ST-T changes, S wave amplitude in leads V2 and V3 and the sum of the R wave amplitude in leads V3 and V4) that were statistically significant by univariate analysis were selected by the model to identify patients with anterior infarction (sensitivity 85%, specificity 71%). The discriminant model was subsequently applied prospectively to an additional 21 patients with poor R wave progression and provided a sensitivity of 85% and a specificity of 88%. Thus, anterior infarction (fixed thallium-201 defects in the anteroseptal segments) was present in 20% of patients with poor R wave progression in the precordial leads; and a mathematical model can be used to identify a subset of patients with anterior infarction in a group of patients with poor R wave progression.

  2. Comparison between Clinically Used Irregular Fields Shielded by Cerrobend and Standard Lead Blocks.

    Science.gov (United States)

    Farajollahi, A R; Bouzarjomehri, F; Kiani, M

    2015-06-01

    In radiation therapy centers across Iran, protection of normal tissues is usually accomplished by either Cerrobend or lead block shielding. In this study, the influence of these two shielding methods on central axis dose distribution of photon beam a Cobalt unit was investigated in clinical conditions. All measurements were performed for 60Co γ-ray beams and the Cerrobend blocks were fabricated by commercial Cerrobend materials. Standard lead block shields belonged to Cobalt unit. Data was collected through a calibrated ionization chamber, relative dosimetry systems and a TLD dosimetery. Results of the percent depth dose (PDD) measurements at depths of 0.5, 1, 5, 10, 15 and 20 cm for 23 different field sizes of patients with head and neck cancer showed no significant differences between lead and Cerrobend shielding methods. Measurement results of absolute dosimetry in depths of 1.5, 3, 5, 7, 10 and 12 cm also showed no significant differences between these two shielding methods. The same results were obtained by TLD dosimetry on patient skin. Use of melt shielding methods is a very easy and fast shield-making technique with no differences in PDD, absolute and skin dose between lead and Cerrobend block shielding methods.

  3. The dearth of the clinic: lead, air, and agency in twentieth-century America.

    Science.gov (United States)

    Sellers, Christopher

    2003-07-01

    By surveying myriad ways that twentieth-century American experts and nonexperts grappled with the health implications of aerial exposures to lead or substances that may have contained lead, this paper urges medical historians' attention toward environments-workplaces, homes and the outdoors-and their extrabodily ontology. Health histories framed around dust, toxins, fumes, and pollution rather than around particular diseases challenge long-accepted narratives, such as Hibbert Hill's old generalization about a "New Public Health" shift from "the environment to the individual." Greater environmental focus can also advance "bottom-up" health history. Pushing the gaze of twentieth-century medical and public health historians beyond hospitals, "public health" departments, clinically confirmable disease, and "patient" roles, it draws historians' attention to health-related realms in which laypeople often claimed greater knowledge and competence.

  4. Factors associated with remission and/or regression of microalbuminuria in type 2 diabetes mellitus.

    Science.gov (United States)

    Ono, Tetsuichiro; Shikata, Kenichi; Obika, Mikako; Miyatake, Nobuyuki; Kodera, Ryo; Hirota, Daisyo; Wada, Jun; Kataoka, Hitomi; Ogawa, Daisuke; Makino, Hirofumi

    2014-01-01

    The aim of this study was to clarify the factors associated with the remission and/or regression of microalbuminuria in Japanese patients with type 2 diabetes mellitus. We retrospectively analyzed the data of 130 patients with type 2 diabetes mellitus with microalbuminuria for 2-6 years (3.39±1.31 years). Remission was defined as improving from microalbuminuria to normoalbuminuria using the albumin/creatinine ratio (ACR), and regression of microalbuminuria was defined as a decrease in ACR of 50% or more from baseline. Progression of microalbuminuria was defined as progressing from microalbuminuria to overt proteinuria during the follow-up period. Among 130 patients with type 2 diabetes mellitus with microalbuminuria, 57 and 13 patients were defined as having remission and regression, respectively, while 26 patients progressed to overt proteinuria. Sex (female), higher HDL cholesterol and lower HbA1c were determinant factors associated with remission/regression of microalbuminuria by logistic regression analysis. Lower systolic blood pressure (SBP) was also correlated with remission/regression, but not at a significant level. These results suggest that proper control of blood glucose, BP and lipid profiles may be associated with remission and/or regression of type 2 diabetes mellitus with microalbuminuria in clinical practice.

  5. Nutritional Strategies in the Management of Adult Patients with Inflammatory Bowel Disease: Dietary Considerations from Active Disease to Disease Remission.

    Science.gov (United States)

    Nguyen, Douglas L; Limketkai, Berkeley; Medici, Valentina; Saire Mendoza, Mardeli; Palmer, Lena; Bechtold, Matthew

    2016-10-01

    Inflammatory bowel disease (IBD) is a group of chronic, lifelong, and relapsing illnesses, such as ulcerative colitis and Crohn's disease, which involve the gastrointestinal tract. There is no cure for these diseases, but combined pharmacological and nutritional therapy can induce remission and maintain clinical remission. Malnutrition and nutritional deficiencies among IBD patients result in poor clinical outcomes such as growth failure, reduced response to pharmacotherapy, increased risk for sepsis, and mortality. The aim of this review is to highlight the consequences of malnutrition in the management of IBD and describe nutritional interventions to facilitate induction of remission as well as maintenance; we will also discuss alternative delivery methods to improve nutritional status preoperatively.

  6. Lenalidomide, as a single agent, induces complete remission in a refractory mantle cell lymphoma

    OpenAIRE

    Tempescul, Adrian; Ianotto, Jean-Christophe; Morel, Frederic; Morel, Frédéric; Marion, Veronique; De Braekeleer, Marc; Berthou, Christian

    2009-01-01

    Lenalidomide, as a single agent, induces complete remission in a refractory mantle cell lymphoma phone: +33-298-223504 (Tempescul, Adrian) (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology, CHU Morvan - Avenue Foch - 29609 - Brest - FRANCE (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology, CHU Morvan - Avenue Foch - 29609 - Brest - FRANCE (Ianotto, Jean-Christophe) ...

  7. SYMPTOM PROFILES OF DSM-IV-DEFINED REMISSION, RECOVERY, RELAPSE, AND RECURRENCE OF DEPRESSION : THE ROLE OF THE CORE SYMPTOMS

    NARCIS (Netherlands)

    Conradi, Henk Jan; Ormel, Johan; de Jonge, Peter

    2012-01-01

    Background Depression outcomes in research and clinical practice are commonly defined by the concepts of remission, recovery, relapse, and recurrence. Despite their widespread use, there has been little empirical examination of these concepts. Therefore, we investigated profiles of individual sympto

  8. Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis.

    Science.gov (United States)

    Starnoni, Daniele; Daniel, Roy Thomas; Marino, Laura; Pitteloud, Nelly; Levivier, Marc; Messerer, Mahmoud

    2016-11-01

    , future prospective studies with long-term follow-up are required to determine the long-term biochemical remission rates and clinical implications.

  9. Multi-lead ECG electrode array for clinical application of electrocardiographic inverse problem.

    Science.gov (United States)

    Hintermuller, Christoph; Fischer, Gerald; Seger, Michael; Pfeifer, Bernhard; Hanser, Friedrich; Modre, Robert; Tilg, Bernhard

    2004-01-01

    Methods for noninvasive imaging of electric function of the heart might become clinical standard procedure the next years. Thus, the overall procedure has to meet clinical requirements as easy and fast application. In this study we propose a new electrode array which improves the information content in the ECG map, considering clinical constraints such as easy to apply and compatibility with routine leads. A major challenge is the development of an electrode array which yields a high information content even for a large interindividual variation in torso shape. For identifying regions of high information content we introduce the concept of a locally applied virtual electrode array. As a result of our analysis we constructed a new electrode array consisting of two L-shaped regular spaced parts and compared it to the electrode array we use for clinical studies upon activation time imaging. We assume that one side effect caused by the regular shape and spacing of the new array be that the reconstruction of electrodes placed on the patients back is simplified. It may be sufficient to record a few characteristic electrode positions and merge them with a model of the posterior array.

  10. 急性早幼粒细胞白血病诱导缓解及序贯治疗方案的临床观察%Clinical observation of acute promyelocytic leukemia remission induction and sequential treatment programs

    Institute of Scientific and Technical Information of China (English)

    宋丽丽; 孙玲

    2013-01-01

    目的 观察急性早幼粒细胞白血病(APL)诱导化疗及缓解后治疗方案.方法 将初诊的28例APL患者给予三氧化二砷(As2O3)、全反式维甲酸(ATRA)联合诱导治疗,白细胞>10×109/L时给予蒽环类化疗[柔红霉素(DNR) 40 mg×3 d].诱导缓解后给予蒽环类强化治疗3个疗程,初治高白细胞的患者加用标准剂量阿糖胞苷.强化治疗结束且患者血象、骨髓象恢复后开始予As2O3、ATRA、巯嘌呤(6-MP)+甲氨蝶呤(MTX)、化疗序贯治疗,观察患者治疗过程中复发率及不良反应.结果 28例患者除1例在治疗初期死于颅内出血外,其余27例均获得血液学缓解,PML/RARα融合基因均转阴.其中5例患者维持治疗结束2年后融合基因仍持续阴性.结论 As2O3、ATRA联合化疗治疗APL疗效确切,且可缩短血液学缓解时间;序贯治疗可以明显降低复发率,缩短患者住院时间,增加患者治疗依从性,提高患者生存质量.%Objective To observe efficacy of acute promyelocytic leukemia (APL) by chemotherapy induction and treatment programs after remission.Methods 28 cases of newly diagnosed APL were treated with combined arsenic trioxide and retinoic acid which was called induced program,the patients whose leukocytes >10×109/L would be given anthracycline chemotherapy (DNR 40 mg × 3 d).Remission induction anthracycline chemotherapy was given after three courses of intensive therapy,the standard-dose cytarabine was used to the patients with high white blood.After the intensive treatment and with the recorery of the patient' s blood,bone marrow sequential therapy was used [arsenic trioxide (As2O3),retinoic acid (ATRA),6-MP + MTX and chemotherapy],during which recurrence rate and adverse reactions in the patient' s course of treatment were observed.Results Except 1 was died of intracranial hemorrhage at the beginning of treatment,the remaining 27 patients had received hematologic remission with PML/RARα fusion gene negative

  11. Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study

    NARCIS (Netherlands)

    Vermeer, M.; Kuper, H.H.; Hoekstra, M.; Haagsma, C.J.; Posthumus, M.D.; Brus, H.L.; Riel, P.L. van; Laar, M.A. van der

    2011-01-01

    OBJECTIVE: Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a tre

  12. Symptomatic Remission in Schizophrenia and its Relationship with Functional Outcome Measures in Indian Population

    Science.gov (United States)

    Jayaraman, Komal; Daniel, Sharon Joe; Ramasamy, Jeyaprakash

    2017-01-01

    Introduction Schizophrenia is a chronic mental disorder with disabling symptoms and variable outcome. Outcome is a multidimensional construct that depends on description of clinical and social domains. Symptomatic remission is one such clinical domain which can determine the outcome of illness. Aim The study aimed to assess functional outcome in symptomatic remitted schizophrenia patients compared to unremitted patients in Indian population. Materials and Methods This cross-sectional observational study was conducted at the Institute of Mental Health, Chennai, India. Remitted (symptom free in preceding six months) and unremitted patients were assessed by Positive and Negative Symptom Scale (PANSS), Personal and Social Performance (PSP) scale, World Health Organization-Quality of Life BREF (WHOQOL-BREF) and Global Assessment of Functioning (GAF). There were 30 patients in each group. All statistical analysis was done using SPSS version 20.0 statistical software. Results Patients in symptomatic remission were found to have better quality of life in personal, environmental and social domains (p<0.01). Their personal and social performance is significantly better in remission group. The overall functioning was assessed by GAF, was better in patients with symptomatic remission (p<0.001). Conclusion Symptomatic remission may be a good indicator of better clinical status, personal and social functioning and quality of life. PMID:28274026

  13. Remission in ankylosing spondylitis and axial spondyloarthritides: A modern understanding of the problem

    Directory of Open Access Journals (Sweden)

    I. Z. Gaydukova

    2016-01-01

    Full Text Available The paper discusses possible approaches to determining remission in ankylosing spondylitis (AS and other axial spondyloarthritides (axSpA. At present, there is no single definition of the concept of remission in axSpA and AS, which is due to both the diversity of manifestations of axSpA and a large number of tools to measure disease activity and the nonsimultaneous change in the degree of clinical and laboratory symptoms, signs of acute inflammation, as evidenced by imaging techniques, and signs of progressive structural changes in the locomotor apparatus in the same patient. Clinical, laboratory, magnetic resonance imaging, and radiographic remissions in a patient cannot be in time, which in turn affects the choice of optimal therapy.The case report demonstrates problems with treatment correction in a patient who has achieved clinical and laboratory remission in the presence of persistent inflammatory signs in the locomotor apparatus, as shown by imaging techniques. Since the guidelines for the follow-up and treatment of patients with nonradiographic axSpA and AS are similar today, the paper considers remission as a general problem for all subtypes of axSpA.

  14. C-peptide levels predict type 2 diabetes remission after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ana M. Ramos-Leví

    2013-10-01

    Full Text Available Background: C-peptide (Cp serves as a surrogate of pancreatic beta-cell reserve. This study evaluates the clinical significance of basal Cp as a predictor of type 2 diabetes (T2D remission after bariatric surgery (BS. Research design and methods: Retrospective study of 22 patients with BMI > 35 kg/m² and T2D who underwent BS. Evaluation of anthropometric and glucose metabolism parameters before BS and at one-year follow-up. Analysis of patients with T2D remission (HbAlc 3.75 ng/mL provided a clinically useful cut-off for prediction of T2D remission. T2D remission rates were different according to median preoperative Cp: 27.3% if Cp 3.8 ng/mL (p = 0.010. Conclusions: Patients with elevated preoperative Cp levels achieve higher rates of T2D remission one year after BS. A Cp concentration > 3.75 ng/mL seems clinically useful.

  15. The spleen and kidney acerbity bowel diarrhoea treatments for remission of ulcerative colitis clinical observation%补肾健脾、涩肠止泻法治疗缓解期溃疡性结肠炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    谢晶日; 张冰; 刘朝霞

    2011-01-01

    Objective:To observe the spleen and kidney acerbity bowel diarrhoea treatments for remission of ulcerative colitis clinical curative effect. Methods: 60 patients with the disease patients were randomly divided into the treatment group and control group each 30 cases, the treatment group to the spleen, kidney acerbity bowel diarrhoea legislation herbal treatment, the control group was used by the salad of both oral treatment. All treatment after eight weeks of the patients were observed the clinical symptoms, the mucous membrane and improve under colonoscopy clinical curative effect. Results: the total effective rate of the treatment group was 93.4%, to 90.0% in the placebo group, the two groups after treating the main symptoms and electronic colonoscopic were significantly improved, but the comparison between groups, there were no statistically significant difference (P>0.05). Conclusion: kidney spleen, acerbity bowel diarrhoea treatments for remission ulcerative colitis curative effect and the western medicine beauty salad diazoxide quite, is the treatment remission of ulcerative colitis effective method.%目的:观察补肾健脾、涩肠止泻法治疗缓解期溃疡性结肠炎的临床疗效.方法:将60例该病患者随机分为治疗组和对照组各30例,治疗组采用以补肾健脾、涩肠止泻立法的中药治疗,对照组采用口服美沙拉嗪片治疗.均治疗8周后观察患者临床症状、结肠镜下黏膜改善情况和临床疗效.结果:总有效率治疗组为93.4%,对照组为90.0%,两组治疗后主要症状及电子结肠镜检查均显著改善,但组间比较,差异均无统计学意义(P>0.05).结论:补肾健脾、涩肠止泻法治疗缓解期溃疡性结肠炎疗效与西药美沙拉嗪相当,是治疗缓解期溃疡性结肠炎的有效方法.

  16. Health status of cable splicers with low-level exposure to lead: results of a clinical survey

    Energy Technology Data Exchange (ETDEWEB)

    Fischbein, A. (Mount Sinai Medical Center, New York); Thornton, J.; Blumberg, W.E.

    1980-07-01

    The results of a cross-sectional clinical field survey of 90 telephone cable splicers are presented. Despite the rare occurrence of clinically overt lead poisoning among cable splicers, the observed prevalence of symptoms was 29% for lead-associated central nervous system symptoms and 21% for gastrointestinal symptoms. These two groups of symptoms were directly related to zinc protoporphyrin (ZPP) levels but no relationship was found between them and blood lead concentrations. Only 5% of the workers had significantly elevated blood lead levels (> 40 ..mu..g/100 ml). Because of the intermittent lead exposure encountered in this trade, individuals were identified with normal blood lead levels associated with elevated zinc protoporphyrin concentrations, indicating the difference in biological significance between exposure-(blood lead) and biological-response tests (ZPP). Suggestion is made that both types of diagnostic tests be utilized in the medical surveillance of lead-exposed workers.

  17. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories.

    Science.gov (United States)

    Lippi, Giuseppe; Blanckaert, Norbert; Bonini, Pierangelo; Green, Sol; Kitchen, Steve; Palicka, Vladimir; Vassault, Anne J; Plebani, Mario

    2008-01-01

    Prevention of medical errors is a major goal of healthcare, though healthcare workers themselves have not yet fully accepted or implemented reliable models of system error, and neither has the public. While there is widespread perception that most medical errors arise from an inappropriate or delayed clinical management, the issue of laboratory errors is receiving a great deal of attention due to their impact on the quality and efficiency of laboratory performances and patient safety. Haemolytic specimens are a frequent occurrence in clinical laboratories, and prevalence can be as high as 3.3% of all of the routine samples, accounting for up to 40%-70% of all unsuitable specimens identified, nearly five times higher than other causes, such as insufficient, incorrect and clotted samples. This article focuses on this challenging issue, providing an overview on prevalence and leading causes of in vivo and in vitro haemolysis, and tentative guidelines on identification and management of haemolytic samples in clinical laboratories. This strategy includes continuous education of healthcare personnel, systematic detection/quantification of haemolysis in any sample, immediate clinicians warning on the probability of in vivo haemolysis, registration of non-conformity, completing of tests unaffected by haemolysis and request of a second specimen for those potentially affected.

  18. Influence of Bariatric Surgery on Remission of Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Paweł Nalepa

    2011-12-01

    Full Text Available The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume, malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.

  19. 肺源性心脏病患者急性发作期和缓解期血浆CNP、ADM的变化及意义%Changes and significants of plasma CNP and ADM levels in acute exacerbation and clinical remission stages of patients with chronic pulmonary heart disease

    Institute of Scientific and Technical Information of China (English)

    刘志强; 夏斌; 黄小红; 徐江祥; 张敏; 王霞; 曹玲玲; 周静; 熊茂华; 陈平君; 金其武

    2011-01-01

    Objective To investigate clinical significance of plasma c-type natriuretic peptide (CNP)and adrenomedullin (ADM)levels in acute exacerbation and clinical remission stages of patients with chronic pulmonary heart disease. Methods Plasma levels of CNP and ADM were measured by radioimmoassay in acute exacerbation and clinical remission stages of 100 patients with chronic pulmonary heart disease, oxygen partial pressure and carbon dioxide partial pressure were also measured at the same time. Plasma levels of CNP and ADM were measured in 60 healthy persons as normal control. Results (1) The plusma levels of CNP [ (60.21±15.48)ng/L, (48.95±29.4)ng/L]and ADM (45.66±28.64,28.95±14.35)pg/ml of acute exacerbation and remission stage patients in observe group are all higher than those of normal control group(20.16±5.56,19.98±5.43)pg/ml,and the differents are significant(both P<0.01 ); (2)Plasma levels of CNP and ADM in acute exacerbation were significantly higher than that in clinical remission stages (P<0.01); (3)Plasma levels of CNP and ADM in patients with pulmonary heart disease were negatively correlated with oxygen partial pressure but has no particular correlation with carbon dioxide partial pressure (r=-0.622,-0.702, all P<0.05 ;r=0.205,0.233,all P>0.05); (4)Plasma level of CNP was positively correlated with that of ADM (r=0.279,P<0.05). Conclusions Plasma levels of CNP and ADM may contribute to the assessment of clinical condition in patient with pulmonary heart disease.%目的 探讨C型利钠肽(CNP)及肾上腺髓质素(ADM)在慢性肺源性心脏病急性发作期和缓解期的水平及其临床意义.方法 以放射免疫法检测观察组100例慢性肺源性心脏病急性加重期和缓解期及正常对照组60例健康体检者血浆CNP、ADM水平的变化,同时测定血氧分压和二氧化碳分压.结果 (1)观察组患者急性加重期和临床缓解期血浆CNP[(60.21±15.48)ng/L,(48.95±29.40)ng/L],ADM[(45.66±28.64)pg/ml,(28

  20. Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease.

    Science.gov (United States)

    Wikholm, Emma; Malmborg, Petter; Forssberg, Maria; Hederos, Carl-Axel; Wikström, Sverre

    2016-01-01

    The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.

  1. Private Schools and Public Benefit: Fees, Fee Remissions, and Subsidies

    Science.gov (United States)

    Davies, Peter

    2011-01-01

    The level of fee remissions offered by private schools bears upon the scope for relying on private schools to provide public benefit. Analyses of education voucher systems have generally ignored the possibility that they will partially crowd out school-financed fee remissions. Moreover, variation in fee remissions between private schools may be…

  2. CCK response in bulimia nervosa and following remission.

    Science.gov (United States)

    Hannon-Engel, Sandra L; Filin, Evgeniy E; Wolfe, Barbara E

    2013-10-02

    The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and inappropriate compensatory (e.g., purging) behavior. Previous studies suggest an abnormal post-prandial response in the satiety-signaling peptide cholecystokinin (CCK) in persons with BN. It is unknown whether this altered response persists following remission or if it may be a potential target for the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This study prospectively evaluated the plasma CCK response and corresponding eating behavior-related ratings (e.g., satiety, fullness, hunger, urge to binge and vomit) in individuals with BN-purging subtype (n=10), RBN-purging subtype (n=14), and healthy controls (CON, n=13) at baseline, +15, +30, and +60 min following the ingestion of a standardized liquid test meal. Subject groups did not significantly differ in CCK response to the test meal. A significant relationship between CCK response and satiety ratings was observed in the RBN group (r=.59, p<.05 two-tailed). A new and unanticipated finding in the BN group was a significant relationship between CCK response and ratings of "urge to vomit" (r=.86, p<.01, two-tailed). Unlike previous investigations, CCK response did not differ in BN and CON groups. Thus the role of symptom severity remains an area of further investigation. Additionally, findings suggest that in this sample, CCK functioning following remission from BN-purging subtype is not different from controls. It remains unknown whether or not CCK functioning may be a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to further elucidate the role of CCK in recovery from BN and its potential target of related novel treatment strategies. © 2013 Elsevier Inc. All rights reserved.

  3. “Everyone Needs a Friend Sometimes” – Social Predictors of Long-term Remission In first Episode psychosis

    Directory of Open Access Journals (Sweden)

    Jone Bjornestad

    2016-10-01

    Full Text Available BackgroundPredictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects.ObjectivesTo test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency.Material and MethodsA sample of first episode psychosis (n=186 completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses.ResultsFrequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects. ConclusionsThe study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates.KeywordsFirst-Episode Psychosis, Schizophrenia, Social factors, Baseline predictors, Long-term remission.

  4. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Kjeldsen, Lene Juel

    2013-01-01

    Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality...... and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE......, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100...

  5. Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads.

    Science.gov (United States)

    Schroyen, Sarah; Adam, Stéphane; Jerusalem, Guy; Missotten, Pierre

    2015-01-01

    Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people's mental and physical health in "normal" aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals' attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients' mental and physical health.

  6. [Ageism and its clinical consequences in oncogeriatry: a review of existing data and intervention leads].

    Science.gov (United States)

    Schroyen, S; Adam, S; Jerusalem, G; Missotten, P

    2014-01-01

    Aging is a risk factor in oncology. Indeed, it is estimated that, in 2030, 70% of diagnosed cancers in the United States will concern subjects older than 65 years. Paradoxically, elderly are often excluded from clinical trials and are undertreated compared to younger patients. An important explanatory factor (and yet still not considered!) for these observations is the age stigma (in other words our stereotypes linked to age, and so ageism), age being actually the main motive for discrimination. In this perspective, our aim is to present ageism manifestations in oncogeriatry and their direct consequences for patients, interlocutors (that is to say health professionals) and interactions between them. Throughout this article, we will enhance our remarks by data from researches in "normal" aging. Before ending, we will give some intervention leads potentially applicable in oncogeriatry, to reduce ageism deleterious effect.

  7. Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

    Science.gov (United States)

    Clarke, Christina M; Persaud, Drepaul David

    2011-03-01

    Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

  8. Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads

    Directory of Open Access Journals (Sweden)

    Schroyen S

    2014-12-01

    Full Text Available Sarah Schroyen,1 Stéphane Adam,1 Guy Jerusalem,2,3 Pierre Missotten1 1University of Liège, Psychology of Aging Unit, 2University of Liège, Laboratory of Medical Oncology, 3CHU Sart Tilman Liege, Department of Medical Oncology, Liège, Belgium Abstract: Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism. These stigmas can result in deleterious consequences for elderly people’s mental and physical health in “normal” aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals’ attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients’ mental and physical health. Keywords: oncogeriatry, clinical approaches, stigmatization, ageism

  9. Impact of Cannabis Use on Long-Term Remission in Bipolar I and Schizoaffective Disorder.

    Science.gov (United States)

    Kim, Sung-Wan; Dodd, Seetal; Berk, Lesley; Kulkarni, Jayashri; de Castella, Anthony; Fitzgerald, Paul B; Kim, Jae-Min; Yoon, Jin-Sang; Berk, Michael

    2015-07-01

    To investigate the impact of regular cannabis use on long-term remission of mood symptoms in bipolar spectrum disorders. The 24-month prospective observational study included patients (n=239) with bipolar I disorder and schizoaffective disorder, bipolar type. Participants were classified as regular cannabis users (three times or more per week) or non-users. The primary outcome measure was the achievement of remission on the evaluations during the 24 months. Of the 234 participants for whom data was available, 25 (10.7%) were regular cannabis users, and the group comprised significantly more males than females. In the total population, cannabis use was significantly associated with decreased likelihood of remission during the 24-month follow-up period. Subgroup analyses showed that cannabis use was significantly associated with lower remission rates on the Hamilton Depression Rating Scale in females (n=139) and patients prescribed mood stabilizers alone (n=151), whereas in males (n=95) and patients prescribed olanzapine and/or a mood stabilizer (n=83), cannabis use was significantly associated with lower remission rates on the Young Mania Rating Scale. Remission rates were lowest in the concurrent cannabis and tobacco smoking group (n=22) followed by the tobacco smoking only group (n=97), and the non-smoker group (n=116). The post-hoc analysis revealed that all remission rates were significantly lower in the concurrent cannabis and the tobacco smoking group compared to the non-smoker group. Cannabis use negatively affects the long-term clinical outcome in patients with bipolar spectrum disorders. A comprehensive assessment and integrated management of cannabis use are required to achieve better treatment outcomes for bipolar spectrum disorders.

  10. Neuropsychological profile of patients with bipolar depression in remission

    Directory of Open Access Journals (Sweden)

    Totić-Poznanović Sanja

    2005-01-01

    Full Text Available Aim. To determine if the patients with bipolar affective disorder, after the depressive phase, would exhibit cognitive impairment in remission. Methods. Twenty three euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty-one healthy subjects in the control group, for the presence of the symptoms of depression. The patients and the control group were tested with a battery of neuropsychological tests. Results. Impairments were found in the patients compared with the control group in tests of verbal learning and memory and in tests of executive function. Verbal learning and memory, as well as executive functions, did not correlate either with the clinical indices of patients, or with the demographic and baseline clinical measures of depression. Conclusion. Impaired verbal learning and memory and executive functions may represent a trait rather than the state variables in bipolar disorder.

  11. [Bariatric surgery is more efficient than medical treatment in achieving remission in diabetes mellitus type 2].

    Science.gov (United States)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-04-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly controlled DMII, have been performed. These trials show that bariatric surgery in general, and the malabsorptive procedures in particular, are more effective than medical treatment in achieving remission of DMII. These procedures should therefore be considered in the treatment of patients with DMII and obesity.

  12. Fedmekirurgi er mere effektiv end medicinsk behandling til opnåelse af remission af type 2-diabetes

    DEFF Research Database (Denmark)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-01-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly...... controlled DMII, have been performed. These trials show that bariatric surgery in general, and the malabsorptive procedures in particular, are more effective than medical treatment in achieving remission of DMII. These procedures should therefore be considered in the treatment of patients with DMII...

  13. Is going into stable symptomatic remission associated with a more positive development of life satisfaction? A 10-year follow-up study of first episode psychosis.

    Science.gov (United States)

    Gardsjord, Erlend Strand; Romm, Kristin Lie; Røssberg, Jan Ivar; Friis, Svein; Barder, Helene Eidsmo; Evensen, Julie; Haahr, Ulrik; Ten Velden Hegelstad, Wenche; Joa, Inge; Johannessen, Jan Olav; Langeveld, Johannes; Larsen, Tor Ketil; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Vaglum, Per; McGlashan, Thomas; Melle, Ingrid

    2017-07-09

    Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. Three hundred and one patients with a first-episode psychosis were included at baseline. At 10-year follow-up 186 were reassessed. QoL was assessed by Lehman's Quality of Life Interview. Remission was defined according to criteria proposed by the Remission in Schizophrenia Working Group. One-way ANOVA, mixed model analysis, bivariate correlations and multiple regression analyses were performed. Patients going into stable symptomatic remission showed a more positive S-QoL-development over the follow-up period and reported higher life satisfaction at 10-year follow-up compared to non-remission. At 10-year follow-up, depressive symptoms and alcohol abuse or dependence explained a significant amount of variance in S-QoL among patients in remission. Among patients in non-remission, PANSS excitative component explained a significant amount of variance in S-QoL. All significant effects were negative. Stable symptomatic remission is associated with a more positive development of overall life satisfaction. Furthermore, different symptoms influence life satisfaction depending on status of remission. This has important clinical implications. While patients in remission might need treatment for depressive symptoms to increase S-QoL, in non-remission measures aiming to decrease hostility and uncooperativeness should be part of the treatment approach. Alcohol problems should be treated regardless of remission status. Copyright © 2017. Published by Elsevier B.V.

  14. An Adult Patient with Ocular Myasthenia and Unusually Long Spontaneous Remission

    Directory of Open Access Journals (Sweden)

    Jasem Al-Hashel

    2014-01-01

    Full Text Available A male patient developed ocular myasthenia gravis (MG at the age of 33. He was anti-acetylcholine receptor antibody (anti-AChR Ab negative. He received cholinesterase blocker for 5 months and went into a complete clinical remission that lasted untreated for 17 years. He relapsed recently with ocular symptoms only. He is now anti-AChR Ab positive and SFEMG is abnormal in a facial muscle. The patient is controlled with steroids. He had one of the longest spontaneous remissions reported in the natural history of MG, particularly unusual for an adult with the disease.

  15. C-peptide levels predict type 2 diabetes remission after bariatric surgery

    OpenAIRE

    Ana M. Ramos-Leví; Pilar Matía; Lucio Cabrerizo; Ana Barabash; María José Torrejón; Andrés Sánchez-Pernaute; Torres, Antonio J.; Rubio, Miguel A.

    2013-01-01

    Background: C-peptide (Cp) serves as a surrogate of pancreatic beta-cell reserve. This study evaluates the clinical significance of basal Cp as a predictor of type 2 diabetes (T2D) remission after bariatric surgery (BS). Research design and methods: Retrospective study of 22 patients with BMI > 35 kg/m² and T2D who underwent BS. Evaluation of anthropometric and glucose metabolism parameters before BS and at one-year follow-up. Analysis of patients with T2D remission (HbAlc < 6%, fasting gluco...

  16. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds® Consensus Exercises

    DEFF Research Database (Denmark)

    de Lautour, Hugh; Taylor, William J; Adebajo, Ade

    2016-01-01

    OBJECTIVES: The aim of this study was to establish consensus for potential remission criteria for use in clinical trials of gout. METHODS: Experts (n=88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were...

  17. Spontaneous remission of acromegaly and Cushing’s disease following pituitary apoplexy: Two case reports

    NARCIS (Netherlands)

    Roerink, S.H.P.P.; Lindert, E.J. van; Ven, A.C. van de

    2015-01-01

    In this double case report, we present two special cases of pituitary apoplexy. First, we describe a patient with growth hormone deficiency despite clinical suspicion of acromegaly. Imaging showed evidence of a recent pituitary apoplexy, which might have caused spontaneous remission of the acromegal

  18. Safety and efficacy of Profermin(R) to induce remission in ulcerative colitis

    DEFF Research Database (Denmark)

    Krag, Aleksander; Israelsen, Hans; von Ryberg, Bjørn;

    2012-01-01

    AIM: To test the efficacy and safety of Profermin(R) in inducing remission in patients with active ulcerative colitis (UC). METHODS: The study included 39 patients with mild to moderate UC defined as a Simple Clinical Colitis Activity Index (SCCAI) > 4 and < 12 (median: 7.5), who were treated ope...

  19. Watchful waiting for minor depression in primary care: remission rates and predictors of improvement.

    Science.gov (United States)

    Hegel, Mark T; Oxman, Thomas E; Hull, Jay G; Swain, Karin; Swick, Holly

    2006-01-01

    The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes. Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement. Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments. There is a low likelihood of spontaneous remission for treatment-seeking samples with minor depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.

  20. Clinical and experimental studies of multiple sclerosis in Russia: experience of the leading national research centers

    Directory of Open Access Journals (Sweden)

    Zavalishin IA

    2015-08-01

    Full Text Available Igor A Zavalishin,1 Alexey A Belogurov Jr,2–4 Yakov A Lomakin,2 Natalia A Ponomarenko,2 Sofia N Morozova,1 Zinaida A Suslina,1,† Michael A Piradov,1 Sergey N Illarioshkin,1 Alexander G Gabibov2–5 1Research Center of Neurology, 2Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, 3Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, 4Institute of Gene Biology, RAS, 5Chemistry Department, Moscow State University, Moscow, Russia †Dr Zinaida A Suslina passed away on June 22, 2014 Abstract: Mechanisms of axonal damage and adaptive capacity in multiple sclerosis (MS, including cortical reorganization, have been actively studied in recent years. The lack of regenerative capabilities and the irreversibility of neurodegeneration in MS are critical factors for the optimization of MS treatment. In this study, we present the results of clinical and basic studies in the field of MS by two leading Russian centers. Clinical and neuroimaging correlations show that spinal damage in MS is accompanied by functional reorganization of the cerebral cortex, which is determined not only by the efferent component but also by the afferent component. Comparative analysis of MS treatment with both interferon β1b (IFN-β1b and IFN-β1a at a dosage of 22 µg for 3 years through subcutaneous administration and glatiramer acetate showed equally high efficiency in reducing the number of exacerbations in relapsing-remitting MS and secondary-progressive MS. We demonstrate a reduced risk of disability in relapsing-remitting MS and secondary-progressive MS patients in all groups treated with IFN-β1 and glatiramer acetate. MS appears to be a disease that would greatly benefit from the development of personalized therapy; thus, adequate molecular predictors of myelin degradation are greatly needed. Therefore, novel ideas related to the viral hypothesis of the etiology of MS and new targets for

  1. Body composition in remission of childhood cancer

    Science.gov (United States)

    Tseytlin, G. Ja; Anisimova, A. V.; Godina, E. Z.; Khomyakova, I. A.; Konovalova, M. V.; Nikolaev, D. V.; Rudnev, S. G.; Starunova, O. A.; Vashura, A. Yu

    2012-12-01

    Here, we describe the results of a cross-sectional bioimpedance study of body composition in 552 Russian children and adolescents aged 7-17 years in remission of various types of cancer (remission time 0-15 years, median 4 years). A sample of 1500 apparently healthy individuals of the same age interval was used for comparison. Our data show high frequency of malnutrition in total cancer patients group depending on type of cancer. 52.7% of patients were malnourished according to phase angle and percentage fat mass z-score with the range between 42.2% in children with solid tumors located outside CNS and 76.8% in children with CNS tumors. The body mass index failed to identify the proportion of patients with malnutrition and showed diagnostic sensitivity 50.6% for obesity on the basis of high percentage body fat and even much less so for undernutrition - 13.4% as judged by low phase angle. Our results suggest an advantage of using phase angle as the most sensitive bioimpedance indicator for the assessment of metabolic alterations, associated risks, and the effectiveness of rehabilitation strategies in childhood cancer patients.

  2. Spontaneous remission of hepatocellular carcinoma without any treatment

    Directory of Open Access Journals (Sweden)

    Shao-Ciao Luo

    2016-12-01

    A 61 year old asymptomatic woman visited our outpatient clinic (OPC with a high alpha-fetal protein (AFP level. A computed tomogram (CT revealed a 4.1 cm hypervascular tumor (arterial phase at S4 of the liver and washed out in venous phase. Her Hepatitis B Surface Antigen (HBsAg was negative and Hepatitis C Antibody (anti-HCV was positive. This patient also had esophageal varices. She refused any treatment and returned to our OPC about 2 years later. Her AFP level was 11.8 ng/ml. The following CT scan revealed a small amount of cirrhosis, but no mass, in the liver, so that spontaneous remission of HCC was determined. She was treated by oral diuretics. Here we report the case and review of literature.

  3. “Everyone Needs a Friend Sometimes” – Social Predictors of Long-Term Remission In First Episode Psychosis

    Science.gov (United States)

    Bjornestad, Jone; Joa, Inge; Larsen, Tor K.; Langeveld, Johannes; Davidson, Larry; ten Velden Hegelstad, Wenche; Anda, Liss G.; Veseth, Marius; Melle, Ingrid; Johannessen, Jan O.; Bronnick, Kolbjorn

    2016-01-01

    Background: Predictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects. Objectives: To test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency. Material and Methods: A sample of first episode psychosis (n = 186) completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses. Results: Frequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects. Conclusions: The study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates. PMID:27757090

  4. The patient simple clinical colitis activity index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission : A comparison of the P-SCCAI with clinician-based SCCAI and biological markers

    NARCIS (Netherlands)

    Bennebroek Evertsz', Floor; Nieuwkerk, Pythia T; Stokkers, Pieter C F; Ponsioen, Cyriel Y; Bockting, Claudi L H; Sanderman, Robbert; Sprangers, Mirjam A G

    2013-01-01

    AIM: To develop a patient-based Simple Clinical Colitis Activity Index (P-SCCAI) of ulcerative colitis (UC) activity and to compare it with the clinician-based SCCAI, C-reactive protein (CRP) and Physician's Global Assessment (PGA) of UC activity. Monitoring UC activity may give patients disease

  5. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy.

    Science.gov (United States)

    Polanco, Natalia; Gutiérrez, Elena; Covarsí, Adelardo; Ariza, Francisco; Carreño, Agustín; Vigil, Ana; Baltar, José; Fernández-Fresnedo, Gema; Martín, Carmen; Pons, Salvador; Lorenzo, Dolores; Bernis, Carmen; Arrizabalaga, Pilar; Fernández-Juárez, Gema; Barrio, Vicente; Sierra, Milagros; Castellanos, Ines; Espinosa, Mario; Rivera, Francisco; Oliet, Aniana; Fernández-Vega, Francisco; Praga, Manuel

    2010-04-01

    Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.

  6. Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

    Science.gov (United States)

    Polanco, Natalia; Gutiérrez, Elena; Covarsí, Adelardo; Ariza, Francisco; Carreño, Agustín; Vigil, Ana; Baltar, José; Fernández-Fresnedo, Gema; Martín, Carmen; Pons, Salvador; Lorenzo, Dolores; Bernis, Carmen; Arrizabalaga, Pilar; Fernández-Juárez, Gema; Barrio, Vicente; Sierra, Milagros; Castellanos, Ines; Espinosa, Mario; Rivera, Francisco; Oliet, Aniana; Fernández-Vega, Francisco

    2010-01-01

    Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 ± 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission. PMID:20110379

  7. Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

    Directory of Open Access Journals (Sweden)

    Neha Singhal

    2016-01-01

    Full Text Available Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups. Statistical Analysis Used: Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups. Results: Fifty-seven (32.7% patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2% patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02. Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively. Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01. The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009. Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.

  8. Symptomatic Remission and Counterfactual Reasoning in Schizophrenia

    Science.gov (United States)

    Albacete, Auria; Contreras, Fernando; Bosque, Clara; Gilabert, Ester; Albiach, Ángela; Menchón, José M.

    2017-01-01

    Counterfactual thinking (CFT) is a type of conditional reasoning involving mental representations of alternatives to past factual events that previous preliminary research has suggested to be impaired in schizophrenia. However, despite the potential impact of these deficits on the functional outcome of these patients, studies examining the role of CFT in this disorder are still few in number. The present study aimed to extent previous results by evaluating CFT in the largest sample to date of schizophrenia patients in symptomatic remission and healthy controls. The relationship with symptomatology, illness duration, and sociodemographic characteristics was also explored. Methods: Seventy-eight schizophrenia patients and 84 healthy controls completed a series of tests that examined the generation of counterfactual thoughts, the influence of the “causal order effect,” and the ability to counterfactually derive inferences by using de Counterfactual Inference Test. Results: Compared with controls, patients generated fewer counterfactual thoughts when faced with a simulated scenario. This deficit was negatively related to scores on all dimensions of the Positive and Negative Syndrome Scale-PANNS, as well as to longer illness duration. The results also showed that schizophrenia patients deviated significantly from the normative pattern when generating inferences from CFT. Conclusions: These findings reveal CFT impairment to be present in schizophrenia even when patients are in symptomatic remission. However, symptomatology and illness duration may have a negative influence on these patients' ability to generate counterfactual thoughts. The results might support the relevance of targeting CFT in future treatment approaches, although further research is needed to better describe the relationship between CFT and both symptomatology and functional outcome. PMID:28111561

  9. Verbal memory functioning in recurrent depression during partial remission and remission-Brief report

    Directory of Open Access Journals (Sweden)

    Åsa eHammar

    2013-10-01

    Full Text Available The aim of the present study was to investigate verbal memory performance in a group of patients with remitted and partial remitted major depressive disorder. Thirty-one patients and 31 healthy matched controls were included in the study. Results from the California Verbal Learning Test show intact verbal memory performance in the patient group regarding learning, recall and recognition. However, patients had significantly poorer performance compared to healthy controls in immediate recall of the first trial in the verbal memory test. In conclusion, the patient group showed intact memory performance, when material is presented more than once. These findings indicate that memory performance in MDD patients with partial remission and remission benefit from repetition of material.

  10. 12-lead Holter electrocardiography. Review of the literature and clinical application update.

    Science.gov (United States)

    Su, Li; Borov, Stefan; Zrenner, Bernhard

    2013-06-01

    This brief review is focused on 12-lead Holter electrocardiogram (ECG) recording including a review of the literature and the description of the advantages of its application. The standard 12-lead ECG provides a bedside snapshot of the electrical activity of the heart including vector information, but a snapshot of a few beats for some seconds might miss the whole story. Traditional Holter ECG displaying two or three leads may record all heart beats during a prolonged period, but the limited vector information might be a cause of shortcomings in the ECG diagnosis. The 12-lead Holter ECG overcomes these disadvantages and should be preferred for detecting episodes of arrhythmias, localize their origin or the localization of myocardial ischemia. The 12-lead Holter ECG monitoring is efficient in the evaluation of the effect of drugs or interventional therapeutic procedures, i.e., efficiency of biventricular pacing in patients with heart failure and permanent atrial fibrillation (AF). The automatic analysis of parameters in 12-lead Holter ECG is also providing information for risk stratification. In order to obtain a precise diagnosis based on the criteria established on standard ECG, the "real" 12-lead ECG with ten electrodes is advocated.

  11. Patients with longstanding ulcerative colitis in remission do not have more irritable bowel syndrome-like symptoms than controls.

    Science.gov (United States)

    Lundgren, D; Rutegård, J; Eklöf, V; Palmqvist, R; Karling, P

    2016-11-24

    Irritable bowel syndrome (IBS) is more common in patients with ulcerative colitis (UC) than expected. The prevalence of IBS in patients with UC with longstanding disease is not known. We investigated the prevalence of IBS-like symptoms in patients with UC in remission and longstanding disease in comparison to control subjects. Sixty-eight patients with UC and 33 patients with hereditary familiar colon cancer and who underwent colonoscopy surveillance were included. Faecal calprotectin (FC), Gastrointestinal Symptoms Rating Scale-Irritable Bowel Syndrome (GSRS-IBS) and Hospital Anxiety and Depression scale were fulfilled prior to endoscopy. UC in remission was define by steroid-free clinical remission, a Mayo Score ≤ 1 on endoscopy, a FC ≤ 200 μg/g and no significant active inflammation on colon biopsies. Fifty-five UC patients met the criteria for being in remission. The median disease duration was 17 years. The patients with UC in remission tended to have lower scores on total GSRS-IBS score (6 vs 10.5; p = 0.062) and lower or equal scores on all specific IBS symptoms in comparison to controls. There was a moderate but significant correlation between diarrhoea scores and FC levels (in the span ≤ 200 μg/g) (rs 0.38; p = 0.004) in the UC in remission group. Patients with UC with longstanding disease and in remission do not have more IBS symptoms than controls. In UC patients in remission the FC level in the lower span showed a moderate correlation to symptoms of diarrhoea.

  12. How can I maintain my patient with diabetes and history of foot ulcer in remission?

    Science.gov (United States)

    Miller, John D; Salloum, Michelle; Button, Alex; Giovinco, Nicholas A; Armstrong, David G

    2014-12-01

    Patients with diabetes and previous history of ulceration occupy the highest category of risk for reulceration and amputation. Annual recurrence rates of diabetic ulcerations have been reported as high as 34%, 61%, and 70% at 1, 3, and 5 years, respectively, with studies reporting 20% to 58% recurrence rate within 1 year. As the ever growing epidemic of diabetes expands globally, this sequelae of diabetic complication will continue to require increasing resources from the healthcare community to effectively manage. Recent data suggest that removal of preventative podiatric care from statewide reimbursement systems lead to significant and sustained increases in hospital admission (37%), charges (38%), length of stay (23%), and severe aggregate outcomes including amputation, sepsis and death (49%). The addition of comorbidities such as peripheral artery disease, poor nutrition, and non-adherence to preventive therapies not only increase a patient's likelihood for ulcer recurrence, but also cost of care and certainty of hospital admission. Currently, numerous efforts, guidelines, and industry generated products exist to prolong remission from ulceration; however, the clinical science for treating this patient population calls for much more effort. Despite this, data continue to suggest to demonstrate that appropriate follow-up care, shoe and insole modification, and patient education play a central role in reducing reulceration and amputation. Novel modalities for offloading and wearable sensor technologies offer the advantage of round-the-clock, patient specific and active response healthcare. These have the potential to detect, or even prevent, many wounds before they begin.

  13. A combination therapy with fludarabine, mitoxantrone and rituximab induces complete immunophenotypical remission in B-cell prolymphocytic leukaemia

    OpenAIRE

    Tempescul, Adrian; Feuerbach, Johanna; Ianotto, Jean-Christophe; Dalbies, Florence; Marion, Veronique; Bris, Marie-Josée; De Braekeleer, Marc; Berthou, Christian

    2008-01-01

    A combination therapy with fludarabine, mitoxantrone and rituximab induces complete immunophenotypical remission in B-cell prolymphocytic leukaemia phone: +33-298-223504 (Tempescul, Adrian) (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology - CHU Morvan, Avenue Foch - 29609 - Brest - FRANCE (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology - CHU Morvan, Avenue Foch - 2...

  14. A randomised double-blind placebo-controlled trial with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 for maintenance of remission in ulcerative colitis

    DEFF Research Database (Denmark)

    Nordgaard, Inge; Rumessen, Jüri Johs.; Wildt, Signe

    2011-01-01

    To investigate the clinical effect of treatment with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 (Probio-Tec AB-25) to maintain remission in patients with ulcerative colitis.......To investigate the clinical effect of treatment with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 (Probio-Tec AB-25) to maintain remission in patients with ulcerative colitis....

  15. Lead tolerance capacity of clinical bacterial isolates and change in their antibiotic susceptibility pattern after exposure to a heavy metal

    Directory of Open Access Journals (Sweden)

    Divya Garhwal

    2014-07-01

    Full Text Available Introduction: Heavy metal pollutions of soil and wastewater are a significant environmental problem as they are not degraded or destroyed. Several metal resistance mechanisms have been identified which is responsible for alteration of normal cell physiology leading to development of drug resistance in microorganisms. Heavy metals used in industry and in household products are, along with antibiotics, creating a selective pressure in the environment that leads to the mutations in microorganisms. The present study was carried out to study the heavy metal lead tolerance by bacteria and change in antibiotic-sensitivity pattern after its exposure. Materials and Methods: 30 clinical isolates from various samples received in the Department of Microbiology, Government Medical College, Surat, were included in the study. To check the lead tolerance capacity, isolates were exposed to graded concentration of lead nitrate by plate dilution method, starting from 50 up to 1000 μg/ml strength. Antibiotic susceptibility was performed by the Kirby Bauer disc diffusion method. A change in antibiotic susceptibility pattern was studied before and after lead exposure. Result: 30 clinical isolates were included in the study, 25 Gram negative (83.3% and 5 Gram positive (16.7%. MIC to lead was higher in Acinetobacter spp. and Pseudomonas spp. (600-1000 μg/ml as compared to E. coli, Klebsiella spp., S. aureus (50-150 μg/ml. Multiple antibiotic resistance indexes were changed significantly after lead exposure. Conclusion: Bacteria exposed to high levels of heavy metals in their environment have adapted to this stress by developing various resistance mechanism. Infection with antibiotic-resistant organisms create problem in treatment and management of patients. We should take efforts to prevent environmental pollution with such heavy metals and transmission of antibiotic-resistant microorganism from environment to health care set up.

  16. Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder.

    Science.gov (United States)

    Johnson, Sheri L; Carver, Charles S

    2016-01-01

    Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.

  17. Temporary remission of disseminated paecilomycosis in a German shepherd dog treated with ketoconazole : case report

    Directory of Open Access Journals (Sweden)

    M.J. Booth

    2001-07-01

    Full Text Available Disseminated mycosis caused by Paecilomyces varioti in a female German shepherd dog presented with chronic forelimb lameness is described. Radiographs of the swollen carpal joint revealed geographic lysis of the radial epiphysis. Diagnosis was based on cytological demonstration of fungal hyphae and chlamydiospores, as well as fungal culture of fluid obtained by arthrocentesis. Temporary remission was characterised by markedly improved clinical signs and laboratory parameters, following treatment with ketoconazole. The dog was euthanased 9 months after the initial diagnosis, following the diagnosis of multifocal discospondylitis. This appears to be the longest described period of temporary remission obtained with treatment in dogs with paecilomycosis. Clinical, clinicopathological and necropsy findings of this disease in another German shepherd dog are briefly described.

  18. Mesalamine in the treatment and maintenance of remission of ulcerative colitis.

    Science.gov (United States)

    Ham, Maggie; Moss, Alan C

    2012-03-01

    Ulcerative colitis (UC) is a chronic disease of the GI tract that is characterized by mucosal inflammation in the colon. Mesalamine (mesalazine) is a 5-aminosalicylic acid compound that is the first-line treatment for patients with mild-to-moderate UC. There are multiple formulations of mesalamine available, primarily differentiated by their means of delivering active mesalamine to the colon. Mesalamine has been demonstrated in randomized controlled trials to induce both clinical response and remission, and maintain clinical remission, in these patients. It has few serious adverse effects and is generally well tolerated by patients. The main areas of uncertainty with use of mesalamine in patients with UC center on the optimal dose for induction of response, how to maintain patient adherence and the role of mesalamine in cancer chemoprophylaxis. Generic forms of mesalamine have yet to be approved by regulatory bodies in the USA.

  19. Integration of clinical chemistry, expression, and metabolite data leads to better toxicological class separation

    DEFF Research Database (Denmark)

    Spicker, Jeppe; Brunak, Søren; Frederiksen, K.S.;

    2008-01-01

    the three toxicants alpha-naphthyl-isothiocyanate, dimethylnitrosamine, and N-methylformamide administered to rats. Improved predictive ability of the different classes is seen, suggesting that this approach is a suitable method for data integration and visualization of biological data. Furthermore......, the method allows for correlation of biological parameters between the different data types, which could lead to an improvement in biological interpretation....

  20. Prevalence and Associated Clinical Characteristics of Exercise-Induced ST-Segment Elevation in Lead aVR

    OpenAIRE

    McKinney, James; Pitcher, Ian; Fordyce, Christopher B.; Yousefi, Masoud; Yeo, Tee Joo; Ignaszewski, Andrew; Isserow, Saul; Chan, Sammy; Ramanathan, Krishnan; Taylor, Carolyn M.

    2016-01-01

    Background Exercise-induced ST-segment elevation (STE) in lead aVR may be an important indicator of prognostically important coronary artery disease (CAD). However, the prevalence and associated clinical features of exercise-induced STE in lead aVR among consecutive patients referred for exercise stress electrocardiography (ExECG) is unknown. Methods All consecutive patients receiving a Bruce protocol ExECG for the diagnosis of CAD at a tertiary care academic center were included over a two-y...

  1. Patterns of symptom onset and remission in episodes of hopelessness depression.

    Science.gov (United States)

    Iacoviello, Brian M; Alloy, Lauren B; Abramson, Lyn Y; Choi, Jimmy Y; Morgan, Julia E

    2013-06-01

    Hopelessness depression (HD) is a subtype of depression postulated by the Hopelessness Theory of Depression to present as a constellation of symptoms occurring when an individual with a specific cognitive vulnerability (negative inferential style) experiences negative life events. In the current study, the course of HD episodes was evaluated prospectively and analyzed to explore patterns of symptom onset and remission. In 169 HD episodes reported by 65 participants, survival analyses were conducted on the time to onset or remission for 29 individual symptoms. Survival analyses yielded probability density graphs for risk of onset and risk of offset that indicated whether the symptom tended to appear or remit early, late, or unpredictably during the episode. The symptom of hopelessness often appeared earliest in HD episodes, followed by self-blame, brooding/worry, decreased self-esteem, dependency, and decreased appetite. Hopelessness, decreased self-esteem, self-blame, brooding/worry, dependency, and increased appetite were typically the latest symptoms to remit. The current study provided evidence for patterns of symptom onset and remission in HD episodes. Hopelessness and other symptoms predicted to appear according to the Hopelessness Theory were generally the earliest to appear, latest to remit, and appeared to form the core syndrome of these HD episodes. Identifying patterns of symptom onset and remission may provide a tool for subtyping depression episodes. Clinically, these results point to the utility of attending to patterns of symptom onset and remission in patients presenting with HD episodes, particularly for treatment planning and monitoring. © 2013 Wiley Periodicals, Inc.

  2. Accuracy of Late-Night Salivary Cortisol in Evaluating Postoperative Remission and Recurrence in Cushing's Disease.

    Science.gov (United States)

    Amlashi, Fatemeh G; Swearingen, Brooke; Faje, Alexander T; Nachtigall, Lisa B; Miller, Karen K; Klibanski, Anne; Biller, Beverly M K; Tritos, Nicholas A

    2015-10-01

    Late-night salivary cortisol (LNSC) is well-validated in the diagnosis of Cushing's disease (CD). The accuracy of LNSC during follow-up of patients undergoing transsphenoidal surgery (TSS) has not been fully characterized. We examined the accuracy of LNSC in establishing remission and identifying recurrence in postoperative patients with CD. This is a retrospective study. Records of patients with CD who underwent TSS by a single neurosurgeon in our tertiary center (2005-2014) were analyzed (N = 224). Patients were selected for further investigation (n = 165) if there was at least one available LNSC test obtained after TSS (either within 3 months or during long-term follow-up). Extracted data included demographic and clinical characteristics, magnetic resonance imaging and laboratory data (morning serum cortisol, 24-hour urine free cortisol [UFC], LNSC) . Remission was defined as nadir morning serum cortisol less than 5 mcg/dl and nadir 24-hour UFC less than 23 mcg. Recurrence was considered definite if confirmed surgically or prompted radiotherapy. Surgical remission occurred in 89% of 89 patients with available LNSC data. LNSC, obtained within 3 months of TSS, established remission with 94% sensitivity and 80% specificity at a cutpoint of 1.9 nmol/l (area under the curve [AUC] = 0.90). At a median follow-up of 53.5 months, LNSC established recurrence (75% sensitivity and 95% specificity) at a cutpoint of 7.4 nmol/l (AUC = 0.87), and 24-hour UFC established recurrence (68% sensitivity and 100% specificity) at a cutpoint of 1.6-fold above normal (AUC = 0.82). LNSC may accurately establish remission after TSS and identify recurrence more accurately than 24-hour UFC during long-term follow-up.

  3. Fecal Microbiota Transplantation Induces Remission in Patients With Active Ulcerative Colitis in a Randomized Controlled Trial.

    Science.gov (United States)

    Moayyedi, Paul; Surette, Michael G; Kim, Peter T; Libertucci, Josie; Wolfe, Melanie; Onischi, Catherine; Armstrong, David; Marshall, John K; Kassam, Zain; Reinisch, Walter; Lee, Christine H

    2015-07-01

    Ulcerative colitis (UC) is difficult to treat, and standard therapy does not always induce remission. Fecal microbiota transplantation (FMT) is an alternative approach that induced remission in small series of patients with active UC. We investigated its safety and efficacy in a placebo-controlled randomized trial. We performed a parallel study of patients with active UC without infectious diarrhea. Participants were examined by flexible sigmoidoscopy when the study began and then were randomly assigned to groups that received FMT (50 mL, via enema, from healthy anonymous donors; n = 38) or placebo (50 mL water enema; n = 37) once weekly for 6 weeks. Patients, clinicians, and investigators were blinded to the groups. The primary outcome was remission of UC, defined as a Mayo score ≤2 with an endoscopic Mayo score of 0, at week 7. Patients provided stool samples when the study began and during each week of FMT for microbiome analysis. The trial was stopped early for futility by the Data Monitoring and Safety Committee, but all patients already enrolled in the trial were allowed to complete the study. Seventy patients completed the trial (3 dropped out from the placebo group and 2 from the FMT group). Nine patients who received FMT (24%) and 2 who received placebo (5%) were in remission at 7 weeks (a statistically significant difference in risk of 17%; 95% confidence interval, 2%-33%). There was no significant difference in adverse events between groups. Seven of the 9 patients in remission after FMT received fecal material from a single donor. Three of the 4 patients with UC ≤1 year entered remission, compared with 6 of 34 of those with UC >1 year (P = .04, Fisher's exact test). Stool from patients receiving FMT had greater microbial diversity, compared with baseline, than that of patients given the placebo (P = .02, Mann-Whitney U test). FMT induces remission in a significantly greater percentage of patients with active UC than placebo, with no difference in

  4. Association with joint damage and physical functioning of nine composite indices and the 2011 ACR/EULAR remission criteria in rheumatoid arthritis.

    Science.gov (United States)

    Klarenbeek, N B; Koevoets, R; van der Heijde, D M F M; Gerards, A H; Ten Wolde, S; Kerstens, P J S M; Huizinga, T W J; Dijkmans, B A C; Allaart, C F

    2011-10-01

    To compare nine disease activity indices and the new American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) remission criteria in rheumatoid arthritis (RA) and to relate these to physical function and joint damage progression. Five-year data from the BeSt study were used, a randomised clinical trial comparing four treatment strategies in 508 patients with recent-onset RA. Every three months disease activity was assessed with nine indices (Disease Activity Score (DAS), DAS-C reactive proteine (DAS-CRP), Disease Activity Score in 28 joints (DAS-28), DAS28-CRP, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and three DAS versions with adjusted tender joint scores) and categorized into remission, low, moderate and high disease activity (LDA, MDA, HDA). In addition, the recent ACR/EULAR clinical trial and practice remission was assessed 3-monthly with 28 and 68/66 joint counts. For each index, Generalized Estimating Equations analyses were performed to relate disease activity levels and the absence/presence of remission to 3-monthly assessments of physical functioning and annual radiological progression. From the composite indices, CDAI and SDAI were the most stringent definitions of remission and classified more patients as LDA. DAS28 and DAS28-CRP had the highest proportions of remission and MDA and a smaller proportion of LDA. ACR/EULAR remission percentages were comparable to CDAI/SDAI: remission percentages. The variant including CRP and 68/66 joint counts was the most stringent. For all indices, higher levels of disease activity were associated with decreased physical functioning and more radiological damage progression. Despite differences in classification between the indices, no major differences in relation to the two outcomes were observed. The associations of nine composite indices and ACR/EULAR remission criteria with functional status and joint damage progression showed high accordance, whereas

  5. Remission Rate and Functional Outcomes During a 6-Month Treatment With Osmotic-Release Oral-System Methylphenidate in Children With Attention-Deficit/Hyperactivity Disorder.

    Science.gov (United States)

    Su, Yi; Li, Haibo; Chen, Yixin; Fang, Fang; Xu, Tong; Lu, Haiping; Xie, Ling; Zhuo, Jianmin; Qu, Jiazhi; Yang, Li; Wang, Yufeng

    2015-10-01

    Many definitions have been used to evaluate remission in patients with attention-deficit/hyperactivity disorder (ADHD) in different studies resulting with varied remission rates. This open-label, multicenter study investigated the remission rate in Chinese children (n = 239; aged 6-16 years) with a diagnosis of ADHD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), treated with osmotic-release oral-system methylphenidate at doses of 18, 36, and 54 mg, once daily. Two definitions of remission were used: (1) (primary end point): average scores of SNAP-IV (Swanson, Nolan, and Pelham, Fourth Edition) items of 1 or less (0-3 rating scale for each item) according to the subtype of ADHD (inattentive [1-9], hyperactive-impulsive [10-18], and combined type [1-18]), and (2) total score of SNAP-IV items 1 to 18 of 18 or less, at week 8. The study consisted of screening/baseline, titration/open-label treatment (8 weeks), and extended observation (up to 24 weeks) phases. Secondary efficacy assessments were Clinical Global Impression-Improvement (clinical efficacy), Behavior Rating Inventory of Executive Function Scale (BRIEF; executive function behaviors), and Weiss Functional Impairment Rating Scale (social function). Validity of remission was assessed by comparing the function measures (BRIEF and Weiss's) between patients who achieved remission and those who did not. At week 8, 69.3% (151/218) of patients achieved remission by definition 1, and 73.2% (161/220) by definition 2. At weeks 8 and 24, the remission group had significantly lower BRIEF, Weiss's, and Clinical Global Impression-Improvement scores (P methylphenidate was well tolerated, with increased remission rates in children with ADHD.

  6. Brief clinical report: an infant with duplication of 17q21 lead to 17qter.

    Science.gov (United States)

    Gallien, J U; Neu, R L; Wynn, R J; Steinberg-Warren, N; Bannerman, R M

    1981-01-01

    Duplication of the distal part of 17q has been reported in 4 patients [1,2]. We are reporting clinical, autopsy, and cytogenetic data on an additional patient whose condition was due to a familial translocation in which the patient's chromosome constitution is 46,XX, der(4),t(4;17)(p16;q21) pat. The phenotype of the five known patients with this duplication is very similar, and their manifestations are distinct enough to be clinically recognizable. Abnormalities common to all five patients are severe growth impairment, craniofacial anomalies with severe hypertelorism, frontal bossing and temporal narrowness, a widow's peak, narrow palpebral fissures, a thin upper lip overlapping a thin lower lip with down-turned corners of the mouth, micrognathia, apparently low-set and deformed ears, short webbed neck, and hyperlaxity of the limbs.

  7. What leads Indians to participate in clinical trials? A meta-analysis of qualitative studies.

    Directory of Open Access Journals (Sweden)

    Jatin Y Shah

    Full Text Available BACKGROUND: With the globalization of clinical trials, large developing nations have substantially increased their participation in multi-site studies. This participation has raised ethical concerns, among them the fear that local customs, habits and culture are not respected while asking potential participants to take part in study. This knowledge gap is particularly noticeable among Indian subjects, since despite the large number of participants, little is known regarding what factors affect their willingness to participate in clinical trials. METHODS: We conducted a meta-analysis of all studies evaluating the factors and barriers, from the perspective of potential Indian participants, contributing to their participation in clinical trials. We searched both international as well as Indian-specific bibliographic databases, including Pubmed, Cochrane, Openjgate, MedInd, Scirus and Medknow, also performing hand searches and communicating with authors to obtain additional references. We enrolled studies dealing exclusively with the participation of Indians in clinical trials. Data extraction was conducted by three researchers, with disagreement being resolved by consensus. RESULTS: Six qualitative studies and one survey were found evaluating the main themes affecting the participation of Indian subjects. Themes included Personal health benefits, Altruism, Trust in physicians, Source of extra income, Detailed knowledge, Methods for motivating participants as factors favoring, while Mistrust on trial organizations, Concerns about efficacy and safety of trials, Psychological reasons, Trial burden, Loss of confidentiality, Dependency issues, Language as the barriers. CONCLUSION: We identified factors that facilitated and barriers that have negative implications on trial participation decisions in Indian subjects. Due consideration and weightage should be assigned to these factors while planning future trials in India.

  8. Novel femoral artery terminology: integrating anatomy and clinical procedures leading to standardized intuitive nomenclature.

    Science.gov (United States)

    Benninger, Brion

    2014-10-01

    The objective of this study is to investigate the terminology of the femoral artery and recommended alternative terminology that satisfies both anatomy and clinical arenas.The femoral artery (FA) is often defined as the continuation of the external iliac artery. Specifically, when the external iliac artery reaches directly beneath the inguinal ligament, it becomes the FA. Currently, Terminologia Anatomica (TA) records the profunda femoris or deep femoral as a terminal branch. Clinicians often use superficial femoral artery (SFA) rather than FA and profunda or deep FA. SFA is actually very deep and well protected for most of its journey. On observation, the terminology in current use is not intuitive. The objective of this study was to investigate the terminology associated with the anatomical and clinical anatomical interpretations of the FA and its terminal branches and to suggest a more appropriate terminology that addresses the points of view of the macro anatomist, as well as that of the clinician. Literature search was conducted regarding the nomenclature of the FA and its terminal branches. Dissection of 89 embalmed cadavers (49F, 40M, ages 47-89) was conducted to analyze the morphology of the FA and its branches. Perusal of the literature revealed a difference in terminology between anatomical and clinical textbooks/atlases/journals regarding the FA and its terminal branch. Our dissections suggested that the FA may be better defined vis-à-vis its relationship to the anterior and posterior compartments of the thigh. A difference in terminology exists between the anatomical and clinical arenas. A need for a standardized terminology is necessary because clinicians and their publishers have not adopted TA. This study suggests that the current FA be considered the common FA and the continuation of the FA, the SFA be renamed the anterior FA and the current profunda (the deep FA) be renamed the posterior FA, respectively. The proposed terminology mirrors the lower

  9. Clinical nurse specialists lead teams to impact glycemic control after cardiac surgery.

    Science.gov (United States)

    Klinkner, Gwen; Murray, Margaret

    2014-01-01

    The purpose of this evidence-based practice improvement project was to improve patients' blood glucose control after cardiac surgery, specifically aiming to keep blood glucose levels less than 200 mg/dL. Glycemic control is essential for wound healing and infection prevention. Multiple factors including the use of corticosteroids and the stress of critical illness put cardiac surgery patients at greater risk for elevated blood glucose levels postoperatively. A Surgical Care Improvement Project measure related to infection prevention calls for the morning blood glucose level (closest to 6:00 AM) to be less than 200 mg/dL on postoperative days 0 to 2. Patients on our cardiothoracic surgery unit were experiencing blood glucose levels greater than benchmark goals. A practice improvement effort was designed to decrease the number of blood glucose results greater than 200 mg/dL after cardiac surgery. The clinical nurse specialists for diabetes and cardiac surgery worked with nursing staff and the interdisciplinary team to implement a 4-pronged approach to improve efficiency in care processes: (1) increase frequency of glucose monitoring, (2) improve accessibility of insulin orders, (3) develop delegation protocol to facilitate nurse-initiated insulin infusion, and (4) implement revised insulin infusion protocol. Hyperglycemia was identified more quickly, and a nurse-initiated protocol prompted more timely use of revised insulin infusion orders and involvement of the diabetes specialty team. Clinically significant improvement in postoperative glycemic control was achieved. Empowering nurses to initiate hyperglycemia treatment and consultation by diabetes specialists may greatly improve efficiency in care processes and clinical outcomes for cardiac surgery patients. Clinical nurse specialists are well positioned to plan and implement interventions that facilitate an evidence-based approach to glycemic management after cardiac surgery.

  10. Continuing professional development: learning that leads to change in individual and collective clinical practice.

    Science.gov (United States)

    May, S A; Kinnison, T

    2015-07-04

    The lack of effectiveness of traditional models of continuing professional development is increasingly recognised. While they can lead to increased knowledge of participants, research suggests that there is a general failure to produce meaningful and sustained changes in clinician behaviours. The aim of this study was to explore the effect of the Royal College of Veterinary Surgeons' (RCVS) new individual outcomes-focused approach to delivery of continuing professional development (CPD) through the reflective accounts of participant experiences. Content analysis of 12 summaries of their learning, produced by early pioneers of the Professional Key Skills (PKS) Module of the RCVS Certificate in Advanced Veterinary Practice, revealed that the benefits of the PKS-related professional development is best understood through 'a framework of 'stakeholder' dynamics', with impact and behavioural change at the individual participant level having an effect on practice team behaviours, leading to patient, owner and business benefits. It can be concluded that, at least for these early pioneers, this new model for CPD has resulted in changes that have gone beyond knowledge accumulation to changed practitioner behaviours and recognisable patient, owner and business benefits. British Veterinary Association.

  11. Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura : only splenectomy induces a complete remission

    NARCIS (Netherlands)

    Louwes, H; Vellenga, E; Houwerzijl, EJ; de Wolf, JTM

    2001-01-01

    Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous disease, whereby it is unclear if and in which way prednisone and splenectomy affect the platelet kinetics leading to a complete remission. To determine the effects of prednisone and splenectomy on the mean platelet life (MPL) and platelet

  12. Prolonged remission of leukemia associated with polycythemia vera.

    Science.gov (United States)

    Hazani, A; Tatarsky, I; Barzilai, D

    1977-09-01

    A patient with polycythemia vera (PV) received successive treatment by phlebotomies, radioactive phosphorus, myleran and cyclophosphamide. Sixteen years after the diagnosis, he developed acute myeloblastic leukemia. A complete remission was achieved following two courses of COAP (cyclophosphamide, vincristine, Cytosine Arabinoside, and prednisone) therapy. Four months later, while still in leukemic remission, he became mildly polycythemic again and the treatment with phlebotomies and cyclophosphamide was resume. The patient has subsequently been in complete remission of leukemia for over three years and his polycythemia is controlled by small doses of cyclophosphamide. This appears to be a unique case of such a prolonged remission of leukemia in the course of PV, with a return to a mild polycythemia state.

  13. Initial clinical experience with implantation of left ventricular lead guided by Overlay Ref for the treatment of congestive heart failure.

    Science.gov (United States)

    Zhang, Bu-Chun; Tang, Kai; Xu, Ya-Wei

    2011-01-01

    Cardiac resynchronization therapy (CRT) improves clinical outcome in selected patients with advanced congestive heart failure. The Overlay Ref technique may facilitate the procedure for implanting left ventricular (LV) pacing leads to deliver CRT. To assess the feasibility of deploying a LV pacing lead into a coronary sinus side branch guided by Overlay Ref. Data from 88 consecutive patients who met the CRT implantation criteria in our hospital between 28 November 2007 and 30 December 2009 were randomly assigned to two groups. Forty-four patients underwent CRT device implantation using Overlay Ref to guide target vein selection and advance a specifically designed pacing lead into the target vein (Overlay Ref group); 44 patients were conventionally implanted (control group). LV lead implantation was successful in all patients. Mean CRT total procedure times (skin-to-skin) were: Overlay Ref group, 80.7 ± 18.0 min; control group, 98.5 ± 32.2 min; p = 0.029. Mean placement of LV pacing lead into target vein times were: Overlay Ref group, 16.2 ± 7.7 min; control group, 36.4 ± 23.4 min; p=0.004. Mean total fluoroscopy times were: Overlay Ref group, 13.6 ± 4.3 min; control group, 23.8 ± 15.7 min; p=0.007. Mean LV lead fluoroscopy times were: Overlay Ref group, 5.7 ± 2.9 min; control group, 14.4 ± 4.6 min; p=0.003. No major complications occurred. Overlay Ref facilitates location of and entry into the coronary sinus, and shortens the duration of LV pacing lead implantation into the target vein. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  14. Factors associated with failure to achieve remission and with relapse after remission in patients with major depressive disorder in the PERFORM study

    Directory of Open Access Journals (Sweden)

    Saragoussi D

    2017-08-01

    Full Text Available Delphine Saragoussi,1 Maëlys Touya,2 Josep Maria Haro,3 Bengt Jönsson,4 Martin Knapp,5 Bastien Botrel,6 Ioana Florea,7 Henrik Loft,8 Benoît Rive9 1Real-World Evidence and Epidemiology, Lundbeck SAS, Issy-les-Moulineaux, France; 2Health Economics and Outcomes Research, Lundbeck, Deerfield, IL, US; 3Research and Teaching Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain; 4Department of Economics, Stockholm School of Economics, Stockholm, Sweden; 5Department of Health Policy, London School of Economics and Political Science, London, UK; 6Biostatistics, Inferential, Paris, France; 7Clinical Research Paediatrics, H. Lundbeck A/S, Valby, Denmark; 8Biometrics, H. Lundbeck A/S, Valby, Denmark; 9Global Analytics, Lundbeck SAS, Issy-les-Moulineaux, France Background: The Prospective Epidemiological Research on Functioning Outcomes Related to Major Depressive Disorder (PERFORM study has been initiated to better understand the course of a depressive episode and its impact on patient functioning. This analysis aimed to identify sociodemographic and clinical factors associated with failure to achieve remission at month 2 after initiating or switching antidepressant monotherapy and with subsequent relapse at month 6 for patients in remission at month 2. Materials and methods: This was a 2-year observational cohort study in 1,159 outpatients aged 18–65 years with major depressive disorder initiating or undergoing the first switch of antidepressant monotherapy. Factors with P<0.20 in univariate logistic regression analyses were combined in a multiple logistic regression model to which backward variable selection was applied (ie, sequential removal of the least significant variable from the model and recomputation of the model until all remaining variables have P<0.05. Results: Baseline factors significantly associated with lower odds of remission at month 2 were body-mass index ≥30 kg/m2 (OR 0

  15. Anti-PIT-1 antibody syndrome; a novel clinical entity leading to hypopituitarism.

    Science.gov (United States)

    Bando, Hironori; Iguchi, Genzo; Yamamoto, Masaaki; Hidaka-Takeno, Ryoko; Takahashi, Yutaka

    2015-03-01

    Various hypothalamic-pituitary diseases cause hypopituitarism. Inflammation related to autoimmunity also causes hypopituitarism. Hypophysitis is a representative disease caused by autoimmunity. Generally, anterior pituitary hormones are non-specifically impaired in this condition, but specific hormone defects have been reported in some cases. Anti-PIT-1 (pituitary-specific transcription factor 1) antibody syndrome is a novel clinical entity that presents an acquired combined pituitary hormone deficiency characterized by a specific defect in growth hormone, prolactin, and thyroid-stimulating hormone. Circulating anti-PIT-1 antibody along with various autoantibodies are detected with multiple endocrine organopathy, meeting the definition of autoimmune polyglandular syndrome. Mechanistically, cytotoxic T lymphocytes that specifically react with PIT-1 protein play an important role in the development of this syndrome.

  16. Severe multi-resistant pemphigus vulgaris: prolonged remission with a single cycle of rituximab.

    Science.gov (United States)

    Corral, Isabela Soubhia; Freitas, Thais Helena Proença de; Aquino, Renata Telles Rudge de; Koller, Daniella Abbruzzini S; Magliari, Maria Elisa Ruffolo; Muller, Helena

    2013-01-01

    Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

  17. A Case of Complex PFO Leading to Ischemic Stroke: A Practical Clinical Pearl for Neurohospitalists.

    Science.gov (United States)

    Coles, Anna; Haveman-Gould, Bradley; Farooq, Muhammad U; Selke, Kristopher J; Gorelick, Philip B

    2016-07-01

    Patent foramen ovale (PFO) has been proposed as a mechanism for cardioembolic stroke, especially in younger patient populations. Complex PFOs, with tunnel lengths exceeding 8 mm, lead to a higher risk of neurological sequelae than simple PFOs and may also be harder to detect with transthoracic echocardiography (TTE). In this article, we present a 29-year-old woman who, after polypharmacy overdose, developed deep venous thrombosis and multiple pulmonary emboli (PE) and subsequent cardioembolic stroke. Initial TTE showed intact interatrial septum with late appearance of agitated saline in the left atrium after the seventh cardiac cycle. Subsequent transesophageal echocardiography, after treatment of PE with an intravenous thrombolytic (alteplase) and anticoagulation with heparin, showed a complex PFO with a 19-mm overlap of the septum primum and secundum without active flow. It is suggested that this PFO allowed for flow only in the situation of elevated right heart strain with PE, causing cardioembolic stroke and detection of agitated saline in the left atrium on TTE. However, under normal physiological situations, which resumed after treatment of PE with alteplase and heparin, the PFO did not allow for flow. This case demonstrates the potential importance of recognition of complex PFOs in diagnosis and management of cardioembolic stroke.

  18. Molecular remission after myeloablative allogeneic stem cell transplantation predicts a better relapse-free survival in patients with multiple myeloma

    NARCIS (Netherlands)

    Corradini, P; Cavo, M; Lokhorst, H; Martinelli, G; Terragna, C; Majolino, [No Value; Valagussa, P; Boccadoro, M; Samson, D; Bacigalupo, A; Russell, N; Montefusco, [No Value; Voena, C; Gahrton, G

    2003-01-01

    Patients in complete clinical remission after myeloablative allogeneic stem cell transplantation (allo-SCT) were enrolled in a longitudinal study to assess the predictive value of molecular monitoring. Using polymerase chain reaction (PCR) for immunoglobulin gene rearrangements it was possible to ge

  19. Cognitive processes and their association with persistence and remission of insomnia: findings from a longitudinal study in the general population.

    Science.gov (United States)

    Norell-Clarke, Annika; Jansson-Fröjmark, Markus; Tillfors, Maria; Harvey, Allison G; Linton, Steven J

    2014-03-01

    Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population. In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper. Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models. The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Synergistic defects of different molecules in the cytotoxic pathway lead to clinical familial hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Zhang, Kejian; Chandrakasan, Shanmuganathan; Chapman, Heather; Valencia, C Alexander; Husami, Ammar; Kissell, Diane; Johnson, Judith A; Filipovich, Alexandra H

    2014-08-21

    Several molecules (LYST, AP3, RAB27A, STX11, STXBP2, MUNC13-4, and PRF1) have been associated with the function of cytotoxic lymphocytes. Biallelic defects in all of these molecules have been associated with familial hemophagocytic lymphohistiocytosis (FHL). We retrospectively reviewed the genetic and immunology test results from 2701 patients with a clinically suspected diagnosis of hemophagocytic lymphohistiocytosis and found 28 patients with single heterozygous mutations in 2 FHL-associated genes. Of these patients, 21 had mutations within PRF1 and a degranulation gene, and 7 were found to have mutations within 2 genes involved in the degranulation pathway. In patients with combination defects involving 2 genes in the degranulation pathway, CD107a degranulation was decreased, comparable to patients with biallelic mutations in one of the genes in the degranulation pathway. This suggests a potential digenic mode of inheritance of FHL as a result of a synergistic function effect within genes involved in cytotoxic lymphocyte degranulation. © 2014 by The American Society of Hematology.

  1. Molecular Mechanisms of Glutamine Synthetase Mutations that Lead to Clinically Relevant Pathologies.

    Directory of Open Access Journals (Sweden)

    Benedikt Frieg

    2016-02-01

    Full Text Available Glutamine synthetase (GS catalyzes ATP-dependent ligation of ammonia and glutamate to glutamine. Two mutations of human GS (R324C and R341C were connected to congenital glutamine deficiency with severe brain malformations resulting in neonatal death. Another GS mutation (R324S was identified in a neurologically compromised patient. However, the molecular mechanisms underlying the impairment of GS activity by these mutations have remained elusive. Molecular dynamics simulations, free energy calculations, and rigidity analyses suggest that all three mutations influence the first step of GS catalytic cycle. The R324S and R324C mutations deteriorate GS catalytic activity due to loss of direct interactions with ATP. As to R324S, indirect, water-mediated interactions reduce this effect, which may explain the suggested higher GS residual activity. The R341C mutation weakens ATP binding by destabilizing the interacting residue R340 in the apo state of GS. Additionally, the mutation is predicted to result in a significant destabilization of helix H8, which should negatively affect glutamate binding. This prediction was tested in HEK293 cells overexpressing GS by dot-blot analysis: Structural stability of H8 was impaired through mutation of amino acids interacting with R341, as indicated by a loss of masking of an epitope in the glutamate binding pocket for a monoclonal anti-GS antibody by L-methionine-S-sulfoximine; in contrast, cells transfected with wild type GS showed the masking. Our analyses reveal complex molecular effects underlying impaired GS catalytic activity in three clinically relevant mutants. Our findings could stimulate the development of ATP binding-enhancing molecules by which the R324S mutant can be repaired extrinsically.

  2. Molecular Mechanisms of Glutamine Synthetase Mutations that Lead to Clinically Relevant Pathologies.

    Science.gov (United States)

    Frieg, Benedikt; Görg, Boris; Homeyer, Nadine; Keitel, Verena; Häussinger, Dieter; Gohlke, Holger

    2016-02-01

    Glutamine synthetase (GS) catalyzes ATP-dependent ligation of ammonia and glutamate to glutamine. Two mutations of human GS (R324C and R341C) were connected to congenital glutamine deficiency with severe brain malformations resulting in neonatal death. Another GS mutation (R324S) was identified in a neurologically compromised patient. However, the molecular mechanisms underlying the impairment of GS activity by these mutations have remained elusive. Molecular dynamics simulations, free energy calculations, and rigidity analyses suggest that all three mutations influence the first step of GS catalytic cycle. The R324S and R324C mutations deteriorate GS catalytic activity due to loss of direct interactions with ATP. As to R324S, indirect, water-mediated interactions reduce this effect, which may explain the suggested higher GS residual activity. The R341C mutation weakens ATP binding by destabilizing the interacting residue R340 in the apo state of GS. Additionally, the mutation is predicted to result in a significant destabilization of helix H8, which should negatively affect glutamate binding. This prediction was tested in HEK293 cells overexpressing GS by dot-blot analysis: Structural stability of H8 was impaired through mutation of amino acids interacting with R341, as indicated by a loss of masking of an epitope in the glutamate binding pocket for a monoclonal anti-GS antibody by L-methionine-S-sulfoximine; in contrast, cells transfected with wild type GS showed the masking. Our analyses reveal complex molecular effects underlying impaired GS catalytic activity in three clinically relevant mutants. Our findings could stimulate the development of ATP binding-enhancing molecules by which the R324S mutant can be repaired extrinsically.

  3. Seguimento do estado de remissão de crianças com artrite idiopática juvenil Remission status follow-up in children with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Taciana A. P. Fernandes

    2007-04-01

    of 3.6 years, were reviewed in order to characterize episodes of inactivity and clinical remission on and off medication. The resulting data were analyzed by means of descriptive statistics, survival analysis, by comparison of Kaplan-Meier curves, log rank testing and binary logistic regression analysis in order to identify predictive factors for remission or persistent activity. RESULTS: One hundred and eight of the cases reviewed fulfilled the inclusion criteria: 57 patients (52.7% exhibited a total of 71 episodes of inactivity, with a mean of 2.9 years per episode; 36 inactivity episodes (50.7% resulted in clinical remission off medication, 35% of which were of the persistent oligoarticular subtype. The probability of clinical remission on medication over 2 years was 81, 82, 97 and 83% for cases of persistent oligoarticular, extended oligoarticular, polyarticular and systemic JIA, respectively. The probability of clinical remission off medication 5 years after onset of remission was 40 and 67% for patients with persistent oligoarticular and systemic JIA, respectively. Persistent disease activity was significantly associated with the use of an anti-rheumatic drug combination. Age at JIA onset was the only factor that predicted clinical remission (p = 0.002. CONCLUSIONS: In this cohort, the probability of JIA progressing to clinical remission was greater for the persistent oligoarticular and systemic subtypes, when compared with polyarticular cases.

  4. Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D

    DEFF Research Database (Denmark)

    Kutyifa, Valentina; Bloch Thomsen, Poul Erik; Huang, David T.

    2013-01-01

    Data on the impact of right ventricular (RV) lead location on clinical outcome and ventricular tachyarrhythmias in cardiac resynchronization therapy with defibrillator (CRT-D) patients are limited.......Data on the impact of right ventricular (RV) lead location on clinical outcome and ventricular tachyarrhythmias in cardiac resynchronization therapy with defibrillator (CRT-D) patients are limited....

  5. Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D

    DEFF Research Database (Denmark)

    Kutyifa, Valentina; Bloch Thomsen, Poul Erik; Huang, David T.;

    2013-01-01

    Data on the impact of right ventricular (RV) lead location on clinical outcome and ventricular tachyarrhythmias in cardiac resynchronization therapy with defibrillator (CRT-D) patients are limited.......Data on the impact of right ventricular (RV) lead location on clinical outcome and ventricular tachyarrhythmias in cardiac resynchronization therapy with defibrillator (CRT-D) patients are limited....

  6. Severity of depression predicts remission rates using transcranial magnetic stimulation

    Directory of Open Access Journals (Sweden)

    Geoffrey eGrammer

    2015-09-01

    Full Text Available Background: Multiple factors likely impact response and remission rates in the treatment of depression with repetitive transcranial magnetic stimulation (rTMS. Notably the role of symptom severity in outcomes with rTMS is poorly understood.Objective/Hypothesis: This study investigated the predictors of achieving remission in patients suffering from depression who receive ≥3 rTMS treatments per week. Methods: Available data on 41 patients treated at Walter Reed National Military Medical Center from 2009 to 2014 were included for analysis. Patients received a range of pulse sequences from 3,000 to 5,000 with left sided or bilateral coil placement. Primary outcome measures were total score on the Patient Health Questionnaire (PHQ-9 or the Quick Inventory of Depressive Symptomatology—Self Rated (QIDS-SR. Remission was defined as a total score less than five, and response was defined as a 50% decrease in the total score on both outcome metrics. Outcomes in patients diagnosed as suffering from mild or moderate depression were compared to those suffering from severe depression. Results: Of the 41 patients receiving treatment, 16 reached remission by the end of treatment. Remission rate was associated with the initial severity of depression, with patients with mild or moderate depression reaching remission at a significantly higher rate than those with severe depression. Total number of rTMS sessions or length of treatment were not predictors of remission. Conclusion: Patients with a baseline level of depression characterized as mild or moderate had significantly better outcomes following rTMS compared to patients with severe depression.

  7. Detection of premature stop codons leading to truncated internalin A among food and clinical strains of Listeria monocytogenes.

    Science.gov (United States)

    Ferreira da Silva, Margarida; Ferreira, Vânia; Magalhães, Rui; Almeida, Gonçalo; Alves, Artur; Teixeira, Paula

    2017-05-01

    Listeria monocytogenes is a food-borne pathogen responsible for outbreaks and sporadic cases of listeriosis, a severe invasive disease. Internalin A (InlA) a protein encoded by inlA has a key role in the mechanism of pathogenesis in L. monocytogenes infection, specifically in the invasion of human intestinal epithelial cells. Studies on inlA have shown that mutations leading to premature stop codons (PMSCs) occur naturally and are associated with impaired virulence of L. monocytogenes strains. Increasing evidence suggests that inlA PMSCs mutations are frequent in strains from foods, but rare among clinical isolates. In this study, 22 L. monocytogenes strains collected in Portugal from the processing environment of a bakery industry (n = 1), different food products (n = 10) and human clinical cases (n = 11) were analysed for mutations in inlA and invasion efficiency in Caco-2 cells. Sequencing revealed previously reported mutations types leading to PMSCs in three food and one clinical strain presenting different molecular serotypes (i.e., IIa, IIb and IIc). The remaining 18 isolates did not show PMSCs in inlA. The four strains with PMSCs in inlA presented lower invasiveness efficiencies in Caco-2 cells (below 8.9%) when compared to the control strain (full-length InlA). In addition, one clinical isolate showed reduced invasion efficiency but no PMSCs in inlA. This isolate showed increased inlA transcript levels to that obtained for the laboratory control strain. Our data support the hypothesis that L. monocytogenes isolated from food have attenuated invasion due to the presence of inlA PMSCs. This information would be critically needed for adequate risk-assessments of the foodborne illness burden associated with L. monocytogenes strains. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records

    Directory of Open Access Journals (Sweden)

    Nichol W Paul

    2011-02-01

    Full Text Available Abstract Background We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS interventions required to support the recently defined "meaningful use" criteria. Methods We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. Results All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. Conclusion If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.

  9. Genetic Determinants of Variable Metabolism Have Little Impact on the Clinical Use of Leading Antipsychotics in the CATIE study

    Science.gov (United States)

    Grossman, Iris; Sullivan, Patrick F.; Walley, Nicole; Liu, Youfang; Dawson, Jeffrey R.; Gumbs, Curtis; Gaedigk, Andrea; Leeder, J. Steven; McEvoy, Joseph P.; Weale, Michael E.; Goldstein, David B.

    2013-01-01

    Purpose To evaluate systematically in real clinical settings whether functional genetic variations in drug metabolizing enzymes influence optimized doses, efficacy, and safety of antipsychotic medications. Methods DNA was collected from 750 patients with chronic schizophrenia treated with five antipsychotic drugs (olanzapine, quetiapine, risperidone, ziprasidone and perphenazine) as part of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Doses for each of the medicines were optimized to 1, 2, 3, or 4x units in identically-appearing capsules in a double blind design. We analyzed 25 known functional genetic variants in the major and minor metabolizing enzymes for each medication. These variants were tested for association with optimized dose and other relevant clinical outcomes. Results None of the tested variants showed a nominally significant main effect in association with any of the tested phenotypes in European-Americans, African-Americans or all patients. Even after accounting for potential covariates no genetic variant was found to be associated with dosing, efficacy, overall tolerability, or tardive dyskinesia. Conclusion There are no strong associations between common functional genetic variants in drug metabolizing enzymes and dosing, safety or efficacy of leading antipsychotics, strongly suggesting merely modest effects on the use of these medicines in most patients in typical clinical settings. PMID:18813134

  10. Pioglitazone could induce remission in major depression: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Colle R

    2016-12-01

    Full Text Available Romain Colle,1,* Delphine de Larminat,1,* Samuel Rotenberg,1 Franz Hozer,1 Patrick Hardy,1 Céline Verstuyft,2 Bruno Fève,3,* Emmanuelle Corruble1,* 1Psychiatry Department, Hôpital Bicêtre, INSERM, UMR S1178, University Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France; 2Molecular Genetic, Pharmacogenetics and Hormonology Department, Hôpital Bicêtre, INSERM UMR_S1184, Centre IMVA, University Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France; 3Endocrinology Department, INSERM UMR_S938, Hôpital Saint-Antoine, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire ICAN, Sorbonne Universités, Université Pierre et Marie Curie, Assistance Publique des Hôpitaux de Paris, Paris, France *These authors contributed equally to this work Background: Pioglitazone, a selective agonist of the nuclear transcription factor peroxisome proliferator-activated receptor-gamma (PPAR-γ, prescribed for the treatment of type 2 diabetes, could have antidepressant properties. However, its potential to induce remission of major depressive episodes, the optimal clinical target for an antidepressant drug, is a matter of concern. Indeed, only one out of four double-blind randomized controlled trials show higher remission rates with pioglitazone than with control treatments. Hence, the main aim of this study was to perform a meta-analysis of the efficacy of pioglitazone for the treatment of MDE, focusing on remission rates.Methods: Four double-blind randomized controlled trials, comprising 161 patients with an MDE, were included in this meta-analysis. Pioglitazone was studied either alone (one study or as add-on therapy to conventional treatments (antidepressant drugs or lithium salts. It was compared either to placebo (three studies or to metformin (one study. Remission was defined by a Hamilton Depression Rating Scale score <8 after treatment.Results: Pioglitazone could induce higher remission

  11. Symptomatic Remission Determines Functional Improvement and Quality of Life in Schizophrenia.

    Science.gov (United States)

    Kokaçya, Mehmet Hanifi; Virit, Osman; Çöpoğlu, Ümit Sertan; Savaş, Haluk; Ari, Mustafa; Bahçeci, Bülent

    2016-12-01

    Schizophrenia is a chronic illness that negatively affects the quality of life and psychosocial functions. Defined criteria to assess remission in schizophrenia are considered to be useful in the long-term follow-up of patients and in discriminating diagnostic factors. This study investigated the quality of life and functionality in schizophrenia patients in symptomatic remission (R-Sch) and not in remission (Non-R-Sch). Sociodemographic data were collected for 40 R-Sch and 40 Non-R-Sch patients, and the following scales were administered: the Clinical Global Impression-Severity (CGI-S) Scale; Positive and Negative Syndrome Scale (PANSS), World Health Organization Quality of Life Questionnaire-Short Form, Turkish Version (WHOQOL-BREF-TR), Quality of Life Scale for Schizophrenia Patients (QLS), and Global Assessment of Functioning Scale (GAF). The total and all subscale scores of PANSS and the CGI-S score were significantly lower in the R-Sch group than in the Non-R-Sch group, whereas the GAF scores and all subscales of QLS and WHOQOL-BREF-TR were significantly higher. This study demonstrates that improvement in symptoms in schizophrenia patients improves quality and functionality in all areas of life, suggesting that an improvement in symptoms is the most important determinant of functional recovery in the treatment of schizophrenia.

  12. Itolizumab provides sustained remission in plaque psoriasis: a 5-year follow-up experience.

    Science.gov (United States)

    Budamakuntla, L; Madaiah, M; Sarvajnamurthy, S; Kapanigowda, S

    2015-03-01

    There is an unmet need for psoriasis therapies that provide long-term remission. Itolizumab is a humanized recombinant anti-CD6 monoclonal antibody shown to be effective in psoriasis. We report a patient who received itolizumab in a phase 2 clinical trial, and experienced long-term remission. At baseline, the patient's Psoriasis Area and Severity Index (PASI) was 12.2, and Physician's Global Assessment (PGA) score was 3. After 8 weeks of treatment, the patient achieved 97% improvement in PASI. She continued to have ≥ 90% improvement, initially for 4 weeks (follow-up phase), and later for 20 weeks (follow-up extension phase). She continued to visit the hospital after the final study visit; her most recent visit was on 10 May 2013. PGA results during the visits revealed sustained response for 4 years and 5 months after stopping itolizumab. Itolizumab could be therefore an important treatment option for moderate to severe psoriasis, with potential to provide long-lasting remission.

  13. An investigation of attributional style, theory of mind and executive functioning in acute paranoia and remission.

    Science.gov (United States)

    Berry, Katherine; Bucci, Sandra; Kinderman, Peter; Emsley, Richard; Corcoran, Rhiannon

    2015-03-30

    This study assessed associations between attributional style and ToM measures in patients with paranoid symptoms and non-clinical controls, as well associations between these aspects of social cognition and executive skills. Using a longitudinal design, we further assessed performance on measures following the remission of paranoid symptoms. Patients and controls completed the Internal Personal and Situational Attributions Questionnaire (IPSAQ), ToM tasks, the Stroop, the modified Wisconsin Card Sorting Test (WCST) and a measure of premorbid IQ at time one. Following the remission of paranoid symptoms, the patient group repeated the assessment process. Patients had a higher personalising bias for negative events and impairments in second order false belief and executive skills compared to control participants. Personalising bias for negative events was associated with poorer IQ, a tendency to make perseverative errors, a poorer performance on the second order false belief task and more severe symptoms. Personalising bias for negative events, performance on the second order false belief task or the tendency to make perseverative errors did not significantly change following symptom remission. The findings increase understanding of the mechanisms that potentially underpin the development and maintenance of paranoia. Specifically targeting personalising attributions for negative events in remitted patients may be an important goal of psychological therapy.

  14. Safety and efficacy of Profermin(R) to induce remission in ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Aleksander Krag; Hans Israelsen; Bjφrn von Ryberg; Klaus K Andersen; Flemming Bendtsen

    2012-01-01

    AIM:To test the efficacy and safety of Profermin(R) in inducing remission in patients with active ulcerative colitis (UC).METHODS:The study included 39 patients with mild to moderate UC defined as a Simple Clinical Colitis Activity Index (SCCAI) > 4 and < 12 (median:7.5),who were treated open-label with Profermin(R) twice daily for 24 wk.Daily SCCAI was reported observer blinded via the Internet.RESULTS:In an intention to treat (ITT) analysis,the mean reduction in SCCAI score was 56.5%.Of the 39 patients,24 (62%) reached the primary endpoint,which was proportion of patients with ≮ 50% reduction in SCCAI.Our secondary endpoint,the proportion of patients in remission defined as SCCAI ≤ 2.5,was in ITT analysis reached in 18 of the 39 patients (46%).In a repeated-measure regression analysis,the estimated mean reduction in score was 5.0 points (95% CI:4.1-5.9,P < 0.001) and the estimated mean time taken to obtain half the reduction in score was 28 d (95% CI:26-30).There were no serious adverse events (AEs) or withdrawals due to AEs.Profermin(R)was generally well tolerated.CONCLUSION:Profermin(R) is safe and may be effective in inducing remission of active UC.

  15. Enduring Changes in Decision Making in Patients with Full Remission from Anorexia Nervosa.

    Science.gov (United States)

    Steward, Trevor; Mestre-Bach, Gemma; Agüera, Zaida; Granero, Roser; Martín-Romera, Virginia; Sánchez, Isabel; Riesco, Nadine; Tolosa-Sola, Iris; Fernández-Formoso, Jose A; Fernández-García, Jose C; Tinahones, Francisco J; Casanueva, Felipe F; Baños, Rosa M; Botella, Cristina; Crujeiras, Ana B; de la Torre, Rafael; Fernández-Real, Jose M; Frühbeck, Gema; Ortega, Francisco J; Rodríguez, Amaia; Jiménez-Murcia, Susana; Menchón, Jose M; Fernández-Aranda, Fernando

    2016-11-01

    Deficits in neuropsychological functioning have consistently been identified in patients with anorexia nervosa (AN). However, little is known on how decision making in AN patients evolves in response to treatment or whether impairments are reversible. AN patients (n = 42) completed the Iowa Gambling Task (IGT) upon admission to a 3-month day-hospital treatment programme and at a 1-year follow-up. Patient IGT performance was compared to age-matched controls (n = 46). AN patients displayed poorer performance on the IGT at admission compared to controls (p < .001). Patients with full remission (n = 31; 73.9%) at the 1-year follow-up improved IGT performance (p = 0.007), and scores were similar compared to controls (p = 0.557). AN patients with partial/no remission at follow-up (n = 11; 26.1%) did not improve IGT scores (p = 0.867). These findings uphold that enduring remission from AN can reverse decision-making impairments, and they might be most likely explained by clinical state rather than a trait vulnerability. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

  16. Sustained remission of Cushing's disease with mitotane and pituitary irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Schteingart, D.E.; Tsao, H.S.; Taylor, C.I.; McKenzie, A.; Victoria, R.; Therrien, B.A.

    1980-05-01

    Low doses of mitotane were given orally to 36 patients with Cushing's disease, concurrently with or after pituitary cobalt irradiation. Clinical and biochemical remission occurred in 29. The response to treatment occurred early in 17 patients and late in 12. The different pattern of response to mitotane was not related to the dose given or to its serum level. Early biochemical indicators of adrenal suppression with mitotane were a sharp decrease in adrenal response to the infusion of ACTH and in plasma levels of dehydroepiandrosterone sulfate. Although mitotane was given together with pituitary irradiation, initial remission was due mainly to the adrenal effect of mitotane. Plasma ACTH levels were still elevated when cortisol had returned to normal. In seventeen of the 29 patients who responded to treatment drug therapy has been discontinued, and they remain in remission of Cushing's syndrome. Side-effects have been dose dependent, with anorexia, nausea, decreased memory, and gynecomastia in men being the commonest.

  17. Use of clinical neurophysiology for the selection of medication in the treatment of major depressive disorder: the state of the evidence.

    Science.gov (United States)

    Leuchter, Andrew F; Cook, Ian A; Hunter, Aimee; Korb, Alex

    2009-04-01

    Approximately 50% of patients with Major Depressive Disorder (MDD) respond to the first antidepressant medication prescribed, and fewer than one-third experience remission of symptoms. The most significant challenge in the management of MDD, therefore, is selection of the antidepressant medication that is most likely to lead to response or to remission for an individual patient. There is a growing body of evidence that certain clinical neurophysiologic techniques may be useful for selecting the medication that is most likely benefit each patient. Use of low resolution electromagnetic tomography (LORETA), loudness dependent auditory evoked potentials (LDAEP), and resting state quantitative electroencephalography (QEEG) in the clinical setting is increasingly supported by studies indicating that these techniques may help identify particular medications that are most likely to lead to response or remission. The current state of evidence supporting the use of each technique is reviewed.

  18. Single-coil and dual-coil defibrillator leads and association with clinical outcomes in a complete Danish nationwide ICD cohort

    DEFF Research Database (Denmark)

    Larsen, Jacob M; Hjortshøj, Søren P; Nielsen, Jens C;

    2016-01-01

    BACKGROUND: The best choice of defibrillator lead in patients with routine implantable cardioverter-defibrillator (ICD) is not settled. Traditionally, most physicians prefer dual-coil leads but the use of single-coil leads is increasing. OBJECTIVE: The purpose of this study was to compare clinical...... outcomes in patients with single- and dual-coil leads. METHODS: All 4769 Danish patients 18 years or older with first-time ICD implants from 2007 to 2011 were included from the Danish Pacemaker and ICD Register. Defibrillator leads were 38.9% single-coil leads and 61.1% dual-coil leads. The primary end...... point was all-cause mortality. Secondary end points were lowest successful energy at implant defibrillation testing, first shock failure in spontaneous arrhythmias, structural lead failure, and lead extraction outcomes. RESULTS: Single-coil leads were associated with lower all-cause mortality...

  19. In cats with newly diagnosed diabetes mellitus, use of a near-euglycemic management paradigm improves remission rate over a traditional paradigm.

    Science.gov (United States)

    Nack, Robert; DeClue, Amy E

    2014-01-01

    The object of this retrospective study was to compare the effect on remission rates of a near euglycemic paradigm (NEP) to a traditional paradigm (TP) of glycemic control in cats with newly diagnosed diabetes mellitus. Medical records of 54 cats with naïve diabetes mellitus managed with low carbohydrate, high protein prescription diets, and twice daily subcutaneous glargine insulin injections were reviewed. Cats were assigned to an NEP or TP group based on frequency of evaluation of blood glucose concentration and the criteria used to assess glycemic control. The two groups were compared with regard to the incidence of clinical and biochemical hypoglycemia and remission rates. Multiple logistic regression was used to evaluate the association between remission and independent variables. Fourteen of 18 cats (78%) in the NEP group achieved remission, whereas five of the 36 (14%) of the TP group achieved remission (p diabetic cats using an NEP of glycemic control results in higher remission rates without an increased incidence of observed clinical or biochemical hypoglycemia. Although an NEP appears to have benefit it should be evaluated further with regard to its overall and long term effects on health and quality of life as well as its overall cost effectiveness.

  20. A new model to predict remission status in AML patients based on day 14 bone marrow biopsy.

    Science.gov (United States)

    Norkin, Maxim; Chang, Myron; An, Qi; Leather, Helen; Katragadda, Lakshmikanth; Li, Ying; Moreb, Jan S; May, W Stratford; Brown, Randy A; Hsu, Jack W; Hiemenz, John W; Wingard, John R; Cogle, Christopher R

    2016-07-01

    Although bone marrow evaluation on day 14 after initiation of induction chemotherapy (D14 BM) is a widely accepted practice in patients with acute myeloid leukemia (AML), it has suboptimal predictive value for predicting complete remission. We retrospectively analyzed pretreatment characteristics and post-induction response in a cohort of AML patients to determine if adding clinical and laboratory characteristics can improve the predictive value of the D14 BM evaluation. Among 297 patients treated for AML at the single institution 183 patients (61%) had leukemia-positive D14 BM. Of those, 94 were given reinduction chemotherapy and 89 were not. Of the 89 patients who did not receive reinduction, 32 (36%) subsequently achieved complete remission (CR) or complete remission with incomplete count recovery (CRi), and 57 (64%) had persistent disease. Persistent disease after positive D14 BM was more likely associated with higher percentage of D14 myeloblasts, a history of relapsed disease before induction, and higher risk disease compared to patients who subsequently achieved CR. Age, diagnostic white blood cell count, and the D14 BM cellularity did not influence the subsequent likelihood of achieving remission in patients with a positive D14 BM. A new mathematical equation was created and resulted in a positive predictive value of 83%, negative predictive value 90% and accuracy 88% for correctly identifying remission status after positive D14 BM in AML. The accuracy of predicting response using these additional parameters was significantly higher than without (0.88 vs. 0.80, P=0.002). Our new model provides better accuracy for predicting the likelihood of achieving remission and if validated in future studies may be useful for managing AML patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Factors associated with sustained remission in patients with rheumatoid arthritis.

    Science.gov (United States)

    Martire, María Victoria; Marino Claverie, Lucila; Duarte, Vanesa; Secco, Anastasia; Mammani, Marta

    2015-01-01

    To find out the factors that are associated with sustained remission measured by DAS28 and boolean ACR EULAR 2011 criteria at the time of diagnosis of rheumatoid arthritis. Medical records of patients with rheumatoid arthritis in sustained remission according to DAS28 were reviewed. They were compared with patients who did not achieved values of DAS28<2.6 in any visit during the first 3 years after diagnosis. We also evaluated if patients achieved the boolean ACR/EULAR criteria. Variables analyzed: sex, age, smoking, comorbidities, rheumatoid factor, anti-CCP, ESR, CRP, erosions, HAQ, DAS28, extra-articular manifestations, time to initiation of treatment, involvement of large joints, number of tender joints, number of swollen joints, pharmacological treatment. Forty five patients that achieved sustained remission were compared with 44 controls. The variables present at diagnosis that significantly were associated with remission by DAS28 were: lower values of DAS28, HAQ, ESR, NTJ, NSJ, negative CRP, absence of erosions, male sex and absence of involvement of large joints. Only 24.71% achieved the boolean criteria. The variables associated with sustained remission by these criteria were: lower values of DAS28, HAQ, ESR, number of tender joints and number of swollen joints, negative CRP and absence of erosions. The factors associated with sustained remission were the lower baseline disease activity, the low degree of functional disability and lower joint involvement. We consider it important to recognize these factors to optimize treatment. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  2. Remission of migraine after clipping of saccular intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, E R; Busygina, A V; Kolotvinov, V S

    2015-01-01

    BACKGROUND: Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches...... of TTH was given by 33 patients with SIA during the year preceding rupture and by 44 during 1 year after clipping (P > 0.75). Forty-one control patients had TTH, 27 after 1 year of treatment, a reduction 34.1% (P aneurysm could explain the remission of migraine...

  3. Data on correlations between T cell subset frequencies and length of partial remission in type 1 diabetes.

    Science.gov (United States)

    Narsale, Aditi; Moya, Rosita; Robertson, Hannah Kathryn; Davies, Joanna Davida

    2016-09-01

    Partial remission in patients newly diagnosed with type 1 diabetes is a period of good glucose control that can last from several weeks to over a year. The clinical significance of the remission period is that patients might be more responsive to immunotherapy if treated within this period. This article provides clinical data that indicates the level of glucose control and insulin-secreting β-cell function of each patient in the study at baseline (within 3 months of diagnosis), and at 3, 6, 9, 12, 18 and 24 months post-baseline. The relative frequency of immune cell subsets in the PBMC of each patient and the association between the frequency of immune cell subsets measured and length of remission is also shown. These data support the findings reported in the accompanying publication, "A pilot study showing associations between frequency of CD4+ memory cell subsets at diagnosis and duration of partial remission in type 1 diabetes" (Moya et al., 2016) [1], where a full interpretation, including biological relevance of the study can be found.

  4. A Cross-sectional, Comparative Study of Insight in Schizophrenia and Bipolar Patients in Remission

    Science.gov (United States)

    Ramachandran, Arul Saravanan; Ramanathan, Rajkumar; Praharaj, Samir Kumar; Kanradi, Haridas; Sharma, Podila Satya Venkata Narasimha

    2016-01-01

    Aims: To study insight correlates in schizophrenia and bipolar mood disorder in remission among out-patients attending the Psychiatry Department of a Tertiary Care Hospital. Settings and Design: In a cross-sectional, naturalistic study, adult patients with schizophrenia and bipolar mood disorder in remission (n = 80; schizophrenia-40, mania-20, bipolar depression-20) were compared on insight measures and clinical correlates. Materials and Methods: Scale to Assess the Unawareness of Mental Disorders (SUMD) was used as the main tool to assess current and past measures of insight. Hogan's Drug Attitude Inventory was used to assess the drug attitude and compliance. Positive and Negative Symptom Scale for Schizophrenia, Young's Mania Rating Scale, and HAMD were used to rate psychopathology. Clinical Global Improvement was used as a screening tool for remission. Statistical Analysis: For comparison of the three clinical groups, analysis of variance and Chi-square test were used. In the post-hoc analysis, the Ryan-Einot-Gabriel-Welsch test was used to find the group difference. Results: About 40% in the schizophrenia group were unaware of their mental illness as against none in the bipolar group. The awareness of mental disorder for the current period, the awareness of the achieved effects of medications, and the awareness of social consequence was better in the bipolar group. The drug attitude (compliant positive attitude) increased as the SUMD item scale decreased or in other words, as the insight improved. Conclusions: Insight, both current and retrospect, showed significant differences between the schizophrenia and bipolar patients. Insight is significantly correlated with the observed compliance and drug attitude of the patient groups. PMID:27335515

  5. A Cross-sectional, comparative study of insight in schizophrenia and bipolar patients in remission

    Directory of Open Access Journals (Sweden)

    Arul Saravanan Ramachandran

    2016-01-01

    Full Text Available Aims: To study insight correlates in schizophrenia and bipolar mood disorder in remission among out-patients attending the Psychiatry Department of a Tertiary Care Hospital. Settings and Design: In a cross-sectional, naturalistic study, adult patients with schizophrenia and bipolar mood disorder in remission (n = 80; schizophrenia-40, mania-20, bipolar depression-20 were compared on insight measures and clinical correlates. Materials and Methods: Scale to Assess the Unawareness of Mental Disorders (SUMD was used as the main tool to assess current and past measures of insight. Hogan's Drug Attitude Inventory was used to assess the drug attitude and compliance. Positive and Negative Symptom Scale for Schizophrenia, Young's Mania Rating Scale, and HAMD were used to rate psychopathology. Clinical Global Improvement was used as a screening tool for remission. Statistical Analysis: For comparison of the three clinical groups, analysis of variance and Chi-square test were used. In the post-hoc analysis, the Ryan-Einot-Gabriel-Welsch test was used to find the group difference. Results: About 40% in the schizophrenia group were unaware of their mental illness as against none in the bipolar group. The awareness of mental disorder for the current period, the awareness of the achieved effects of medications, and the awareness of social consequence was better in the bipolar group. The drug attitude (compliant positive attitude increased as the SUMD item scale decreased or in other words, as the insight improved. Conclusions: Insight, both current and retrospect, showed significant differences between the schizophrenia and bipolar patients. Insight is significantly correlated with the observed compliance and drug attitude of the patient groups.

  6. A remissão em esquizofrenia é possível? Is remission in schizophrenia possible?

    Directory of Open Access Journals (Sweden)

    Hélio Elkis

    2007-01-01

    Full Text Available CONTEXTO: O conceito de remissão já está bem definido em algumas patologias psiquiátricas, como é o caso do transtorno depressivo, porém só recentemente foi proposto um critério para esquizofrenia. OBJETIVO: Revisar o novo conceito de remissão em esquizofrenia. MÉTODO: Revisão da literatura usando o PubMed. RESULTADOS: Os conceitos de resposta, remissão, estabilidade e recuperação são amplamente discutidos neste artigo, bem como os itens das escalas utilizados para definição. CONCLUSÃO: O conceito de remissão caracteriza-se pela presença nos últimos 6 meses de sintomas que atingem um nível máximo de gravidade (nível 3 da Panss mas que permitem um certo funcionamento social. As dimensões do conceito e seus respectivos sintomas psicopatológicos são: Positiva: alucinações, delírios, conteúdo incomum do pensamento. Desorganização: desorganização conceitual, maneirismos e postura. Negativa: afeto embotado, afastamento social passivo/apático, falta de espontaneidade no fluxo da conversação.BACKGROUND: The concept of remission is well established in some psychiatric disorders such as depression, but only recently it has been proposed for schizophrenia. OBJECTIVE: The aim of the present paper is to review the new proposed criteria for remission in schizophrenia. METHOD: PubMed search. RESULTS: The concept of remission, response, stability and recover are extensively discussed in the present article, as well as items of the scales used in the definition. CONCLUSION: The concept of remission is characterized by the presence in the last 6 months of symptoms with a maximum threshold severity level (Panss level 3 but which allows a certain degree of social functioning. The dimensions of the concept and respective psychopathological symptoms are: Positive: delusions, hallucinations and unusual thought content. Disorganization: conceptual disorganization and mannerisms and posturing; Negative: blunted affect, passive

  7. A two-way enriched clinical trial design: combining advantages of placebo lead-in and randomized withdrawal.

    Science.gov (United States)

    Ivanova, Anastasia; Tamura, Roy N

    2015-12-01

    A new clinical trial design, designated the two-way enriched design (TED), is introduced, which augments the standard randomized placebo-controlled trial with second-stage enrichment designs in placebo non-responders and drug responders. The trial is run in two stages. In the first stage, patients are randomized between drug and placebo. In the second stage, placebo non-responders are re-randomized between drug and placebo and drug responders are re-randomized between drug and placebo. All first-stage data, and second-stage data from first-stage placebo non-responders and first-stage drug responders, are utilized in the efficacy analysis. The authors developed one, two and three degrees of freedom score tests for treatment effect in the TED and give formulae for asymptotic power and for sample size computations. The authors compute the optimal allocation ratio between drug and placebo in the first stage for the TED and compare the operating characteristics of the design to the standard parallel clinical trial, placebo lead-in and randomized withdrawal designs. Two motivating examples from different disease areas are presented to illustrate the possible design considerations.

  8. Fecal microbiota transplantation inducing remission in Crohn's colitis and the associated changes in fecal microbial profile.

    Science.gov (United States)

    Kao, Dina; Hotte, Naomi; Gillevet, Patrick; Madsen, Karen

    2014-08-01

    Inflammatory bowel disease (IBD) is a chronic relapsing disorder of the intestine of unclear etiology. Increasing evidence has pointed to intestinal dysbiosis as a potential factor in a genetically susceptible individual. Fecal microbiota transplantation (FMT) has been used to treat inflammatory bowel disease with variable degrees of success. Herein, we report a patient with Crohn's colitis, previously failing an immunosuppressant, who achieved clinical, endoscopic, and histologic remission after a single fecal microbiota transplantation infusion. We have further characterized the changes in the fecal microbiota associated with this observation.

  9. Ménétrier's disease: Long-term remission with lanreotide.

    Science.gov (United States)

    Heurgué-Berlot, Alexandra; Féron, Thomas; Jazeron, Jean-François; Hoeffel, Christine; Diebold, Marie-Danièle; Cadiot, Guillaume

    2016-02-01

    Ménétrier's disease is a rare hypertrophic gastropathy, causing protein leak. An overexpression of transforming growth factor alpha is involved. In inhibiting the epidermal growth factor receptor, cetuximab and somatostatin analogues are the two most promising treatments, allowing to avoid radical gastrectomy. We report the case of a patient with a sustained clinical remission after treatment with lanreotide, but without complete endoscopic healing. We discuss the available therapeutic options and present a literature review of somatostatin analogues for the treatment of Ménétrier's disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Dedicated Research Time During Surgery Residency Leads to a Significant Decline In Self-Assessed Clinical Aptitude and Surgical Skills.

    Science.gov (United States)

    Grova, Monica M; Yang, Anthony D; Humphries, Misty D; Galante, Joseph M; Salcedo, Edgardo S

    2017-05-19

    The surgical community commonly perceives a decline in surgical and patient care skills among residents who take dedicated time away from clinical activity to engage in research. We hypothesize that residents perceive a decline in their skills because of dedicated research time. UC Davis Medical Center, Sacramento, CA, an institutional tertiary care center. General surgery residents and graduates from UC Davis general surgery residency training program, who had completed at least 1 year of research during their training. A total of 35 people were asked to complete the survey, and 19 people submitted a completed survey. Participants were invited to complete an online survey. Factors associated with the decline in skills following their research years were examined. All statistical analyses were performed with IBM SPSS Statistics software. A total of 19 current or former general surgery residents responded to the survey (54% response rate). Overall, 42% described their research as "basic science." Thirteen residents (68%) dedicated 1 year to research, while the remainder spent 2 or more years. Basic science researchers were significantly more likely to report a decrease in clinical judgment (75% vs. 22%, p = 0.013) as well as a decrease in patient care skills (63% vs. 0%, p = 0.002). Residents who dedicated at least 2 years to research were more likely to perceive a decline in overall aptitude and surgical skills (100% vs. 46%, p = 0.02), and a decline in patient care skills (67% vs. 8%, p = 0.007). Most residents who dedicate time for research perceive a decline in their overall clinical aptitude and surgical skills. This can have a dramatic effect on the confidence of these residents in caring for patients and leading a care team once they re-enter clinical training. Residents who engaged in 2 or more years of research were significantly more likely to perceive these problems. Further research should determine how to keep residents who are interested in academics

  11. Weight Suppression Predicts Time to Remission from Bulimia Nervosa

    Science.gov (United States)

    Lowe, Michael R.; Berner, Laura A.; Swanson, Sonja A.; Clark, Vicki L.; Eddy, Kamryn T.; Franko, Debra L.; Shaw, Jena A.; Ross, Stephanie; Herzog, David B.

    2011-01-01

    Objective: To investigate whether, at study entry, (a) weight suppression (WS), the difference between highest past adult weight and current weight, prospectively predicts time to first full remission from bulimia nervosa (BN) over a follow-up period of 8 years, and (b) weight change over time mediates the relationship between WS and time to first…

  12. Radiological, pathological and DNA remission in recurrent metastatic nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Chan Anthony TC

    2006-10-01

    Full Text Available Abstract Background Circulating plasma Epstein Barr Virus DNA (EBV-DNA is a sensitive and specific marker of nasopharyngeal carcinoma (NPC. The mainstay of treatment of metastatic NPC is systemic chemotherapy and resection for solitary metastasis. Despite high response rate to chemotherapy, complete remission is uncommonly seen. Case Presentation We report a case of recurrent metastatic NPC in a 43-year-old man, who achieved complete remission three times with chemotherapy and surgery. Serial plasma EBV-DNA levels were measured during the course of disease. The patient had three episodes of recurrences of NPC manifested as distant metastasis. Both time, rise in the plasma EBV-DNA level preceded detection of recurrences by imaging. Following systemic chemotherapy, he achieved complete remission each time, of which was confirmed by 18-flourodeoxyglucose positron emission tomography and hepatectomy pathology. The plasma EBV-DNA level dropped to zero copy/ml at the time of each remission. Conclusion This case highlights the high chemosensitivity of NPC by illustrating a rare occurrence of complete response of metastatic NPC to chemotherapy. This case also underscores the usefulness of EBV-DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response.

  13. Radiological, pathological and DNA remission in recurrent metastatic nasopharyngeal carcinoma

    Science.gov (United States)

    Chan, Stephen L; Hui, Edwin P; Leung, Sing F; Chan, Anthony TC; Ma, Brigette BY

    2006-01-01

    Background Circulating plasma Epstein Barr Virus DNA (EBV-DNA) is a sensitive and specific marker of nasopharyngeal carcinoma (NPC). The mainstay of treatment of metastatic NPC is systemic chemotherapy and resection for solitary metastasis. Despite high response rate to chemotherapy, complete remission is uncommonly seen. Case Presentation We report a case of recurrent metastatic NPC in a 43-year-old man, who achieved complete remission three times with chemotherapy and surgery. Serial plasma EBV-DNA levels were measured during the course of disease. The patient had three episodes of recurrences of NPC manifested as distant metastasis. Both time, rise in the plasma EBV-DNA level preceded detection of recurrences by imaging. Following systemic chemotherapy, he achieved complete remission each time, of which was confirmed by 18-flourodeoxyglucose positron emission tomography and hepatectomy pathology. The plasma EBV-DNA level dropped to zero copy/ml at the time of each remission. Conclusion This case highlights the high chemosensitivity of NPC by illustrating a rare occurrence of complete response of metastatic NPC to chemotherapy. This case also underscores the usefulness of EBV-DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response. PMID:17076893

  14. Weight Suppression Predicts Time to Remission from Bulimia Nervosa

    Science.gov (United States)

    Lowe, Michael R.; Berner, Laura A.; Swanson, Sonja A.; Clark, Vicki L.; Eddy, Kamryn T.; Franko, Debra L.; Shaw, Jena A.; Ross, Stephanie; Herzog, David B.

    2011-01-01

    Objective: To investigate whether, at study entry, (a) weight suppression (WS), the difference between highest past adult weight and current weight, prospectively predicts time to first full remission from bulimia nervosa (BN) over a follow-up period of 8 years, and (b) weight change over time mediates the relationship between WS and time to first…

  15. Periowave demonstrates bactericidal activity against periopathogens and leads to improved clinical outcomes in the treatment of adult periodontitis

    Science.gov (United States)

    Street, Cale N.; Andersen, Roger; Loebel, Nicolas G.

    2009-02-01

    Periodontitis affects half of the U.S. population over 50, and is the leading cause of tooth loss after 35. It is believed to be caused by growth of complex bacterial biofilms on the tooth surface below the gumline. Photodynamic therapy, a technology used commonly in antitumor applications, has more recently been shown to exhibit antimicrobial efficacy. We have demonstrated eradication of the periopathogens Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans in vitro using PeriowaveTM; a commercial photodisinfection system. In addition, several clinical studies have now demonstrated the efficacy of this treatment. A pilot study in the U.S. showed that 68% of patients treated with PeriowaveTM adjunctively to scaling and root planing (SRP) showed clinical attachment level increase of >1 mm, as opposed to 30% with SRP alone. In a subsequent larger study, a second PeriowaveTM treatment 6 weeks after initial treatment led to pocket depth improvements of >1.5 mm in 89% of patients. Finally, in the most recent multicenter, randomized, examiner-blinded study conducted on 121 subjects in Canada, PeriowaveTM treatment produced highly significant gains in attachment level (0.88 mm vs. 0.57 mm; p=0.003) and pocket depth (0.87 mm vs. 0.63 mm; p=0.01) as compared to SRP alone. In summary, PeriowaveTM demonstrated strong bactericidal activity against known periopathogens, and treatment of periodontitis using this system produced significantly better clinical outcomes than SRP alone. This, along with the absence of any adverse events in patients treated to date demonstrates that PDT is a safe and effective treatment for adult chronic periodontitis.

  16. Lymphoma Remissions Caused by Anti-CD19 Chimeric Antigen Receptor T Cells Are Associated With High Serum Interleukin-15 Levels.

    Science.gov (United States)

    Kochenderfer, James N; Somerville, Robert P T; Lu, Tangying; Shi, Victoria; Bot, Adrian; Rossi, John; Xue, Allen; Goff, Stephanie L; Yang, James C; Sherry, Richard M; Klebanoff, Christopher A; Kammula, Udai S; Sherman, Marika; Perez, Arianne; Yuan, Constance M; Feldman, Tatyana; Friedberg, Jonathan W; Roschewski, Mark J; Feldman, Steven A; McIntyre, Lori; Toomey, Mary Ann; Rosenberg, Steven A

    2017-03-14

    Purpose T cells genetically modified to express chimeric antigen receptors (CARs) targeting CD19 (CAR-19) have potent activity against acute lymphoblastic leukemia, but fewer results supporting treatment of lymphoma with CAR-19 T cells have been published. Patients with lymphoma that is chemotherapy refractory or relapsed after autologous stem-cell transplantation have a grim prognosis, and new treatments for these patients are clearly needed. Chemotherapy administered before adoptive T-cell transfer has been shown to enhance the antimalignancy activity of adoptively transferred T cells. Patients and Methods We treated 22 patients with advanced-stage lymphoma in a clinical trial of CAR-19 T cells preceded by low-dose chemotherapy. Nineteen patients had diffuse large B-cell lymphoma, two patients had follicular lymphoma, and one patient had mantle cell lymphoma. Patients received a single dose of CAR-19 T cells 2 days after a low-dose chemotherapy conditioning regimen of cyclophosphamide plus fludarabine. Results The overall remission rate was 73% with 55% complete remissions and 18% partial remissions. Eleven of 12 complete remissions are ongoing. Fifty-five percent of patients had grade 3 or 4 neurologic toxicities that completely resolved. The low-dose chemotherapy conditioning regimen depleted blood lymphocytes and increased serum interleukin-15 (IL-15). Patients who achieved a remission had a median peak blood CAR(+) cell level of 98/μL and those who did not achieve a remission had a median peak blood CAR(+) cell level of 15/μL ( P = .027). High serum IL-15 levels were associated with high peak blood CAR(+) cell levels ( P = .001) and remissions of lymphoma ( P < .001). Conclusion CAR-19 T cells preceded by low-dose chemotherapy induced remission of advanced-stage lymphoma, and high serum IL-15 levels were associated with the effectiveness of this treatment regimen. CAR-19 T cells will likely become an important treatment for patients with relapsed lymphoma.

  17. Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy: Which joints and tendons should be assessed to predict unstable remission?

    Science.gov (United States)

    Janta, Iustina; Valor, Lara; De la Torre, Inmaculada; Martínez-Estupiñán, Lina; Nieto, Juan Carlos; Ovalles-Bonilla, Juan Gabriel; Martínez-Barrio, Julia; Bello, Natalia; Hinojosa, Michelle; Montoro, María; González, Carlos Manuel; López-Longo, Javier; Monteagudo, Indalecio; Carreño, Luis; Naredo, Esperanza

    2016-03-01

    The aim of the study was to investigate the predictive value of different reduced joint ultrasound (US) assessments of synovitis and tenosynovitis in relation to unstable remission in a cohort of rheumatoid arthritis (RA) patients on methotrexate therapy. Forty-seven RA patients (38 women, 9 men), being treated with methotrexate (MTX), in clinical remission as judged by their consultant rheumatologist were evaluated for disease activity according to the Disease Activity Score (DAS) 28 at baseline and 6 months. Sustained remission and unstable remission were defined according to the baseline and 6-month DAS28 and changes in RA therapy during the follow-up. Each patient underwent at baseline a B-mode and power Doppler (PD) assessment of 44 joints and 20 tendons/tendon compartments by a rheumatologist blinded to the clinical and laboratory data. B-mode synovial hypertrophy (SH), synovial PD signal, B-mode tenosynovitis, and Doppler tenosynovitis were scored 0-3. The presence and index of synovial PD signal in 44 joints [odds ratio (OR) 8.21 (p = 0.016) and OR 2.20 (p = 0.049), respectively] and in 12 joints [OR 5.82 (p = 0.041) and OR 4.19 (p = 0.020), respectively], the presence of SH in wrist and MCP joints [OR 4.79 (p = 0.045)], and the presence of synovial PD signal in wrist-MCP-ankle-MTP joints [OR 4.62 (p = 0.046)] were predictors of unstable remission. The 12-joint or wrist-hand-ankle-MTP US assessments can predict unstable remission in RA patients in apparent clinical remission being treated with MTX.

  18. Clinical routine implantation of a dual chamber pacemaker system designed for safe use with MRI: a single center, retrospective study on lead performance of Medtronic lead 5086MRI in comparison to Medtronic leads 4592-53 and 4092-58.

    Science.gov (United States)

    Wollmann, C G; Thudt, K; Vock, P; Globits, S; Mayr, H

    2011-12-01

    We report our experience concerning lead performance and re-surgery rate of the Medtronic EnRhythm MRI SureScan pacemaker system (MRI-PM) in comparison to standard pacemaker (PM) systems and leads used at our institution. All patients (except patients with transvenous left ventricular leads) with successful PM implantation performed at our institution from 1 March 2009 to 31 October 2009 were included in this analysis and followed until mid January 2010. Lead measurements (assessed at implantation, prehospital discharge interrogation (1st follow-up) and at the first scheduled out-patient follow-up (2nd follow-up) were compared between atrial leads 4592-53 cm and 5086MRI-52 cm (lead group 1), and between ventricular leads 4092-58 cm and 5086MRI-52 cm/-58 cm (lead group 2), respectively. Causes for re-operations were assessed and compared between patients with standard dual chamber PM (DC-PM) and the MRI-PM. A total of 140 patients (VVI-PM: 36 patients; DDD-PM: 102 patients; biventricular PM: 1 patient) were successfully implanted with a PM within the implantation period. Two patients with transvenous left ventricular leads were excluded from further analysis. In an atrial position, lead 4592 was implanted in 51 patients and lead 5086MRI-52 cm was implanted in 40 patients, respectively. Ventricular leads were lead 4092-58 cm (64 patients) and lead 5086MRI (41 patients), respectively. Patients were followed for 26 ± 11 weeks. Comparison of lead measurements of lead group 1 showed significant differences for pacing impedance and pacing threshold at implantation, and for sensing at the 2nd follow-up. Comparison of lead measurements within lead group 2 showed significant differences for pacing impedance at implantation, for pacing threshold at the 1st follow-up, and for sensing, pacing threshold, and impedance at the 2nd follow-up. All assessed mean values were favorable for all leads at any follow-up. The number of re-operations was high in

  19. From rehabilitation to remission in ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    A. Spadaro

    2011-06-01

    Full Text Available During the past years, exercise and non-steroidal anti-inflammatory drugs (NSAIDs have been the mainstay of symptom control for Ankylosing Spondylitis (AS, a chronic, inflammatory rheumatic disease characterized by inflammatory back pain due to sacroiliitis and spondylitis. The ASsessment in AS (ASAS international working group has constructed evidence based recommendations to guide the physician in the management of AS (1. Among the major recommendations for the management of AS, the ASAS group stated that there is a level Ib evidence that NSAIDs improve spinal pain, peripheral joint pain, and function, but comparative studies (1 or population-based survey (2 of different NSAIDs/coxib have not demonstrated one preparation to be clearly better than the others. Wanders et al (3 showed that the clinical efficacy of continuous NSAIDs/coxib treatment for AS was similar to intermittent ‘‘on demand’’ use and they suggested that the continuous treatment with NSAIDs/coxib could slow the radiographic disease progression over 2 years...

  20. Concept of Remission in Chronic Plaque Psoriasis.

    Science.gov (United States)

    Gisondi, Paolo; Di Mercurio, Marco; Idolazzi, Luca; Girolomoni, Giampiero

    2015-11-01

    Psoriasis is a lifelong chronic inflammatory disease affecting 2-3% of the worldwide population. Current understanding of the pathogenesis of psoriasis assigns central importance to an interaction between acquired and innate immunity. The disease is characterized by a series of linked cellular changes in the skin, including hyperplasia of epidermal keratinocytes, angiogenesis, and infiltration of T lymphocytes, neutrophils, and other types of leukocytes in the affected skin. Plaque psoriasis is the most common clinical form and is characterized by red and scaly plaques generally localized at extensor sites such as elbows and knees. Major determinants of psoriasis severity include the extent of skin involvement; localization in highly affected areas such as scalp, palms, and soles; pruritus; presence of comorbidities including psoriatic arthritis; and impairment on quality of life. About one-third of patients have moderate to severe psoriasis defined as PASI (Psoriasis Area and Severity Index) and/or Dermatology Life Quality Index>10, and/or affected body surface area>10%. The optimal treatment goal is to safely achieve complete or almost complete skin clearance. Treatments available are various and they are chosen according to disease features, comorbidities, and patient characteristics and priorities. Topical treatments including corticosteroids and Vitamin D analogs are reserved for mild disease. Phototherapy, cyclosporine, methotrexate, acitretin, or biologics such as tumor necrosis factor-α antagonists and ustekinumab are reserved for the moderate to severe forms.

  1. CD26: A Prognostic Marker of Acute Lymphoblastic Leukemia in Children in the Post Remission Induction Phase.

    Science.gov (United States)

    Mehde, Atheer Awad; Yusof, Faridah; Adel Mehdi, Wesen; Zainulabdeen, Jwan Abdulmohsin

    2015-01-01

    ALL is an irredeemable disease due to the resistance to treatment. There are several influences which are involved in such resistance to chemotherapy, including oxidative stress as a result of the generation of reactive oxygen species (ROS) and presence of hypodiploid cells. Cluster of differentiation 26 (CD26), also known as dipeptidyl peptidase-4, is a 110 kDa, multifunctional, membrane-bound glycoprotein. The aim of this study was to evaluate the clinical significance of serum CD26 in patients with acute lymphoblastic leukaemia patients in the post remission induction phase, as well as the relationship between CD26 activity and the oxidative stress status. CD26, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI), in addition to activity of related enzymes myeloperoxidase, glutathione- s-transferase and xanthine oxidase, were analysed in sixty children with acute lymphoblastic leukaemia in the post remission induction phase. The study showed significant elevation in CD26, TOS and OSI levels in patients with acute lymphoblastic leukaemia in the post remission induction phase in comparison to healthy control samples. In contrast, myeloperoxidase, glutathione-s-transferase and xanthine oxidase activities were decreased significantly. A significant correlation between CD26 concentration and some oxidative stress parameters was evident in ALL patients. Serum levels of CD26 appear to be useful as a new biomarker of oxidative stress in children with acute lymphoblastic leukaemia in the post remission induction phase, and levels of antioxidants must be regularly estimated during the treatment of children with ALL.

  2. Rates and predictors of remission, recurrence and conversion to bipolar disorder after the first lifetime episode of depression--a prospective 5-year follow-up study.

    Science.gov (United States)

    Bukh, J D; Andersen, P K; Kessing, L V

    2016-04-01

    In depression, non-remission, recurrence of depressive episodes after remission and conversion to bipolar disorder are crucial determinants of poor outcome. The present study aimed to determine the cumulative incidences and clinical predictors of these long-term outcomes after the first lifetime episode of depression. A total of 301 in- or out-patients aged 18-70 years with a validated diagnosis of a single depressive episode were assessed from 2005 to 2007. At 5 years of follow-up, 262 patients were reassessed by means of the life chart method and diagnostic interviews from 2011 to 2013. Cumulative incidences and the influence of clinical variables on the rates of remission, recurrence and conversion to bipolar disorder, respectively, were estimated by survival analysis techniques. Within 5 years, 83.3% obtained remission, 31.5% experienced recurrence of depression and 8.6% converted to bipolar disorder (6.3% within the first 2 years). Non-remission increased with younger age, co-morbid anxiety and suicidal ideations. Recurrence increased with severity and treatment resistance of the first depression, and conversion to bipolar disorder with treatment resistance, a family history of affective disorder and co-morbid alcohol or drug abuse. The identified clinical characteristics of the first lifetime episode of depression should guide patients and clinicians for long-term individualized tailored treatment.

  3. Do Short and Sustained Periods of American College of Rheumatology/European League Against Rheumatism Remission Predict Functional and Radiographic Outcome in Early Rheumatoid Arthritis Patients With Low Overall Damage Progression?

    Science.gov (United States)

    Konijn, Nicole P C; van Tuyl, Lilian H D; Boers, Maarten; den Uyl, Debby; Ter Wee, Marieke M; Kerstens, Pit; Voskuyl, Alexandre E; van Schaardenburg, Dirkjan; Nurmohamed, Michael T; Lems, Willem F

    2017-07-01

    To investigate whether remission at single and consecutive visits predicts good outcome in early rheumatoid arthritis (RA). The presence of remission according to American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) and other criteria (Boolean clinical, Clinical Disease Activity Index, Disease Activity Score [DAS], DAS in 28 joints, and Routine Assessment of Patient Index Data 3) was assessed in early RA patients during the first year of the Combination Therapy for Rheumatoid Arthritis light trial. Likelihood ratios were used to assess whether meeting the remission criteria at single visits (13, 26, 39, or 52 weeks) and consecutive visits (13 and 26, 26 and 39, or 39 and 52 weeks) predicted good outcome in the second year (52-104 weeks). Good outcome was defined for function (Health Assessment Questionnaire score consistently ≤0.5 and no deterioration), radiographic damage progression (no deterioration in Sharp/van der Heijde scores), and both ("overall good outcome"). Of the original 164 trial patients, 144 had evaluable data. In the second year, good functional outcome was observed in 35%, good radiographic outcome in 79%, and both in 28% of the patients. Almost all criteria predicted good functional and good overall outcome, at both single and consecutive visits; only single DAS remission did not significantly predict good overall outcome (P = 0.07). Sustained remission periods resulted in higher likelihood ratios than remission at single visits. None of the criteria predicted good radiographic outcome. Early RA patients who reached remission according to ACR/EULAR and other criteria during short or sustained periods were likely to retain good physical function in the subsequent months. Sustained remission periods were a stronger predictor than remission at single visits. However, in the setting of low overall damage progression, (sustained) remission was not predictive of good radiographic outcome. © 2016, American College of

  4. The clinical application of a PACS-dependent 12-lead ECG and image information system in E-medicine and telemedicine.

    Science.gov (United States)

    Hsieh, Jui-Chien; Lo, Hsiu-Chiung

    2010-08-01

    This study presents a software technology to transform paper-based 12-lead electrocardiography (ECG) examination into (1) 12-lead ECG electronic diagnoses (e-diagnoses) and (2) mobile diagnoses (m-diagnoses) in emergency telemedicine. While Digital Imaging and Communications in Medicine (DICOM)-based images are commonly used in hospitals, the development of computerized 12-lead ECG is impeded by heterogeneous data formats of clinically used 12-lead ECG instrumentations, such as Standard Communications Protocol (SCP) ECG and Extensible Markup Language (XML) ECG. Additionally, there is no data link between clinically used 12-lead ECG instrumentations and mobile devices. To realize computerized 12-lead ECG examination procedures and ECG telemedicine, this study develops a DICOM-based 12-lead ECG information system capable of providing clinicians with medical images and waveform-based ECG diagnoses via Picture Archiving and Communication System (PACS). First, a waveform-based DICOM-ECG converter transforming clinically used SCP-ECG and XML-ECG to DICOM is applied to PACS for image- and waveform-based DICOM file manipulation. Second, a mobile Structured Query Language database communicating with PACS is installed in physicians' mobile phones so that they can retrieve images and waveform-based ECG ubiquitously. Clinical evaluations of this system indicated the following. First, this developed PACS-dependent 12-lead ECG information system improves 12-lead ECG management and interoperability. Second, this system enables the remote physicians to perform ubiquitous 12-lead ECG and image diagnoses, which enhances the efficiency of emergency telemedicine. These findings prove the effectiveness and usefulness of the PACS-dependent 12-lead ECG information system, which can be easily adopted in telemedicine.

  5. Remission in psoriatic arthritis: is it possible and how can it be predicted?

    LENUS (Irish Health Repository)

    Saber, Tajvur P

    2010-01-01

    Since remission is now possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFalpha) therapy and to examine possible predictors of response.

  6. Prediction of remission in Graves' disease after thionamide therapy by technetium-99m early uptake

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takashi; Dokoh, Shigeharu; Koh, Toshikiyo; Shimbo, Shin-ichiro (Kyoto City Hospital, Kyoto (Japan)); Hidaka, Akinari; Iida, Yasuhiro; Kasagi, Kanji; Konishi, Junji

    1991-02-01

    In the clinical management of Graves' thyrotoxicosis, one of the most important subject is when to stop antithyroid drugs after achieving an euthyroid state. T{sub 3} suppression test and other methods have been used to forecast the outcome after drug cessation, but the results were not always satisfactory. We have attempted to predict remission of Graves' disease by single measurement of early technetium uptake without administration of triiodothyronine. Drugs were discontinued in the seventy-five patients with Graves' disease on maintenance doses of either methimazole or propylthiouracil who showed normalized uptake (4.0% or less). Of 64 patients evaluable after twelve months, 55 (86%) remained euthyroid, 8 relapsed, and 1 became hypothyoid. With its accuracy in prediction of short-term remission comparable or superior to T{sub 3} suppression test, this rapid and simple method seemed suitable for routine use in clinical practice. (author).

  7. PDF-ECG in clinical practice: A model for long-term preservation of digital 12-lead ECG data.

    Science.gov (United States)

    Sassi, Roberto; Bond, Raymond R; Cairns, Andrew; Finlay, Dewar D; Guldenring, Daniel; Libretti, Guido; Isola, Lamberto; Vaglio, Martino; Poeta, Roberto; Campana, Marco; Cuccia, Claudio; Badilini, Fabio

    2017-08-12

    In clinical practice, data archiving of resting 12-lead electrocardiograms (ECGs) is mainly achieved by storing a PDF report in the hospital electronic health record (EHR). When available, digital ECG source data (raw samples) are only retained within the ECG management system. The widespread availability of the ECG source data would undoubtedly permit successive analysis and facilitate longitudinal studies, with both scientific and diagnostic benefits. PDF-ECG is a hybrid archival format which allows to store in the same file both the standard graphical report of an ECG together with its source ECG data (waveforms). Using PDF-ECG as a model to address the challenge of ECG data portability, long-term archiving and documentation, a real-world proof-of-concept test was conducted in a northern Italy hospital. A set of volunteers undertook a basic ECG using routine hospital equipment and the source data captured. Using dedicated web services, PDF-ECG documents were then generated and seamlessly uploaded in the hospital EHR, replacing the standard PDF reports automatically generated at the time of acquisition. Finally, the PDF-ECG files could be successfully retrieved and re-analyzed. Adding PDF-ECG to an existing EHR had a minimal impact on the hospital's workflow, while preserving the ECG digital data. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. [Shielding effect of clinical X-ray protector and lead glass against annihilation radiation and gamma rays of 99mTc].

    Science.gov (United States)

    Fukuda, Atsushi; Koshida, Kichiro; Yamaguchi, Ichiro; Takahashi, Masaaki; Kitabayashi, Keitarou; Matsubara, Kousuke; Noto, Kimiya; Kawabata, Chikako; Nakagawa, Hiroto

    2004-12-01

    Various pharmaceutical companies in Japan are making radioactive drugs available for positron emission tomography (PET) in hospitals without a cyclotron. With the distribution of these drugs to hospitals, medical check-ups and examinations using PET are expected to increase. However, the safety guidelines for radiation in the new deployment of PET have not been adequately improved. Therefore, we measured the shielding effect of a clinical X-ray protector and lead glass against annihilation radiation and gamma rays of (99m)Tc. We then calculated the shielding effect of a 0.25 mm lead protector, 1 mm lead, and lead glass using the EGS4 (Electron Gamma Shower Version 4) code. The shielding effects of 22-mm lead glass against annihilation radiation and gamma rays of (99m)Tc were approximately 31.5% and 93.3%, respectively. The clinical X-ray protector against annihilation radiation approximately doubled the skin-absorbed dose.

  9. Lead - nutritional considerations

    Science.gov (United States)

    Lead poisoning - nutritional considerations; Toxic metal - nutritional considerations ... Markowitz M. Lead poisoning. In: Kliegman RM, Behrman RE, Jenson HB, ... Emergency Medicine: Concepts and Clinical Practice . 8th ed. ...

  10. Neuropsychological profile of patients with bipolar depression in remission

    OpenAIRE

    Totić-Poznanović Sanja; Marinković Dragan; Pavlović Dragan; Paunović Vladimir R.

    2005-01-01

    Aim. To determine if the patients with bipolar affective disorder, after the depressive phase, would exhibit cognitive impairment in remission. Methods. Twenty three euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty-one healthy subjects in the control group, for the presence of the symptoms of depression. The patients and the control group were tested with a battery of neuropsychological tests. Results. Impairments were found in the patients compared wit...

  11. Bariatric surgery and diabetes remission: Who would have thought it?

    Directory of Open Access Journals (Sweden)

    Awadhesh Kumar Singh

    2015-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1 st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.

  12. Hashimoto's encephalopathy: A long-lasting remission induced by intravenous immunoglobulins

    Directory of Open Access Journals (Sweden)

    Drulović Jelena

    2011-01-01

    Full Text Available Background. Hashimoto's encephalopathy (HE is a rare autoimmune syndrome characterized by various neuropsychiatric manifestations, responsive to steroid treatment and associated with Hashimoto's thyroiditis. There are only a few reports suggesting that intravenous immunoglobulins (IVIG might represent an efficacious treatment modality for the severe steroid-resistant HE cases. We presented a patient with HE who developed a complete recovery after the IVIG therapy followed by a long-lasting remission. Case report. We described herien a female patient with the one-year history of autoimmune thyroiditis before the development of neuropsychiatric manifestations. In May 1999, a 38-year-old woman presented at the Institute of Neurology, Clinical Center of Serbia, Belgrade, with the brain-stem syndrome which responded well to steroid treatment. After detailed examinations, the diagnosis of Hashimoto's encephalopathy was established. Two years later, in June 2001, new manifestations (unsteadiness in gait, personality changes, seizures, and persistent headache gradually developed during a 6-month period. Response to steroids was unsatisfactory and partial, since headaches and personality changes had continuously worsened. In January 2002, the patient received IVIG (0.4 g/kg body weight daily for 5 days. Gradual improvement was noticed and a complete recovery developed over the following weeks. Up to March 2009, during a 7-year follow-up period, remission persisted. Conclusion. To our best knowledge, this is the first report of a long-lasting remission of Hashimoto’s encephalopathy after IVIG therapy. Therefore, this case further supports administration of IVIG, as a potentially beneficial treatment modality, in severe cases of Hashimoto's encephalopathy which are completely or partially resistant to steroids.

  13. [Clinical manifestations of lead levels in children exposed to automobile battery recycling processes in Soacha and Bogotá, D.C].

    Science.gov (United States)

    Hurtado, Carlos Mauricio; Gutiérrez, Myriam; Echeverry, Jairo

    2008-03-01

    Lead is a harmless metal if not handled directly in the industrial process. Even thought lead has been eliminated from the gasoline in many countries, automobile battery recycling continues to be a potential source of exposure and intoxication for the workers and their families, particularly of low income. The current investigation was initiated after an index case of lead poisoning was reported from Soacha, Cundinamarca, in central Colombia. Clinical investigation established lead levels and lead poison frequency in children with para-occupational lead exposure in the process of recycling automobile batteries. This was designed as a descriptive study, with selection of subjects with high risk of possible lead exposure. Minors, mostly of school age were recruited based on referral by relatives, neighbors or acquaintances, all of whom were involved in para-occupational exposure. Thirty two children, less than 12 years old (majority school age), were included. General and specific examinations of the children were made, and blood samples were taken for lead and hematological determinations. All subjects showed high levels of lead (2-9 times the maximum acceptable value) and, according to established criteria, two-thirds were rated as severely poisoned. The children with high levels of lead had tendency toward more specific hematological compromise and showing black gingival bordering (Burton border). This study communicates to the sanitary authorities and government a clear sign of alarm in that measures must be taken to diminish the occupational or para-occupational lead exposure of children by way of the automobile battery recycling industry.

  14. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

    Directory of Open Access Journals (Sweden)

    Nannini C

    2013-01-01

    Full Text Available Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta NanniniDivision of Rheumatology, Misericordia e Dolce Hospital, Prato, ItalyBackground: The aim of this study was to evaluate the proportion of patients with ankylosing spondylitis maintaining clinical remission after reduction of their subcutaneous etanercept dose to 50 mg every other week compared with that in patients receiving etanercept 50 mg weekly.Methods: In the first phase of this randomized, prospective, follow-up study, all biologic-naïve patients identified between January 2005 and December 2009 as satisfying the modified New York clinical criteria for ankylosing spondylitis treated with etanercept 50 mg weekly were evaluated for disease remission in January 2010. In the second phase, patients meeting the criteria for remission were randomized to receive subcutaneous etanercept as either 50 mg weekly or 50 mg every other week. The randomization allocation was 1:1. Remission was defined as Bath Ankylosing Spondylitis Disease Activity Index < 4, no extra-axial manifestations of peripheral arthritis, dactylitis, tenosynovitis, or iridocyclitis, and normal acute-phase reactants. The patients were assessed at baseline, at weeks 4 and 12, and every 12 weeks thereafter. The last visit constituted the end of the follow-up.Results: During the first phase, 78 patients with ankylosing spondylitis (57 males and 21 females, median age 38 years, median disease duration 12 years were recruited. In January 2010, after a mean follow-up of 25 ± 11 months, 43 (55.1% patients achieving clinical remission were randomized to one of the two treatment arms. Twenty-two patients received etanercept 50 mg every other week (group 1 and 21 received etanercept 50 mg weekly (group 2. At the end of follow-up, 19 of 22 (86.3% subjects in group 1 and 19 of 21 (90.4% in group 2 were still in remission, with no significant difference between the two groups. The mean follow-up duration in group

  15. Could Externalized St. Jude Medical Riata® Lead Be a Culture Medium of a Polymicrobial Endocarditis? A Clinical Case

    Directory of Open Access Journals (Sweden)

    Zefferino Palamà

    2017-01-01

    Full Text Available We report the case of a man affected by polymicrobial endocarditis developed on a St. Jude Medical Riata lead with a malfunction because of the outsourcing of conductors. The patient was treated with antibiotic targeted therapy and showed different bacteria at the blood cultures and then underwent transvenous leads extraction. Vegetations were highlighted on the caval, atrial, and ventricular tracts of the Riata lead, but the cultures were all negative. The externalization of Riata lead may cause the malfunction but it could also promote bacterial colonies and vegetations. In conclusion, looking for early signs of infection is mandatory during Riata leads follow-up checks.

  16. Low fecal calprotectin predicts sustained clinical remission in inflammatory bowel disease patients: a plea for deep remission

    NARCIS (Netherlands)

    Mooiweer, E.; Severs, M.; Schipper, M.E.; Fidder, H.H.; Siersema, P.D.; Laheij, R.J.; Oldenburg, B.

    2015-01-01

    BACKGROUND AND AIMS: Mucosal healing has become the treatment goal in patients with ulcerative colitis (UC) and Crohn's disease (CD). Whether low fecal calprotectin levels and histological healing combined with mucosal healing is associated with a further reduced risk of relapses is unknown. METHODS

  17. Low fecal calprotectin predicts sustained clinical remission in inflammatory bowel disease patients : a plea for deep remission

    NARCIS (Netherlands)

    Mooiweer, Erik; Severs, Mirjam; Schipper, Marguerite E I; Fidder, Herma H; Siersema, Peter D; Laheij, Robert J F; Oldenburg, Bas

    2015-01-01

    BACKGROUND AND AIMS: Mucosal healing has become the treatment goal in patients with ulcerative colitis (UC) and Crohn's disease (CD). Whether low fecal calprotectin levels and histological healing combined with mucosal healing is associated with a further reduced risk of relapses is unknown. METHODS

  18. Anti-phospholipase A2 receptor antibody levels at diagnosis predicts spontaneous remission of idiopathic membranous nephropathy

    Science.gov (United States)

    Jullien, Perrine; Seitz Polski, Barbara; Maillard, Nicolas; Thibaudin, Damien; Laurent, Blandine; Ollier, Edouard; Alamartine, Eric; Lambeau, Gérard

    2017-01-01

    Abstract Background: The diagnostic role of circulating anti-phospholipase A2 receptor antibodies (anti-PLA2R Abs) is now well recognized in idiopathic membranous nephropathy (iMN). These Abs could also be interesting as predictors of clinical outcome. In this study, we explored the prognostic value of anti-PLA2R Abs measured in a cohort of iMN patients, with a special focus on their ability to detect patients achieving spontaneous remission. Methods: All adult patients with biopsy-proven iMN diagnosed between 1978 and 2007 were retrospectively screened in our centre. Using a validated enzyme-linked immunosorbent assay, levels of anti-PLA2R Abs were measured from serum samples obtained at the time of renal biopsy and stored at −80°C until processing. Clinical data on disease activity, treatments and outcomes were collected by reviewing patients’ medical records. The association between anti-PLA2R Ab titres and clinical activity/outcome was assessed by Cox proportional hazard and Kaplan–Meier methods. Results: In this retrospective study, 68 patients were included in the final analysis (median follow-up of 81 months). No significant association was found between anti-PLA2R Ab titres at diagnosis with baseline proteinuria, baseline estimated glomerular filtration rate or chronic kidney disease progression. Spontaneous remission was observed in 22% of patients. Ab titres were significantly and gradually correlated in a dose–response manner with the likelihood of spontaneous remission. Conclusions: While Ab titres measured at diagnosis were not found to predict the activity of iMN, evaluation of anti-PLA2R Ab titres might prove useful in the early identification of patients likely to achieve spontaneous remission. PMID:28396737

  19. Prolonged P-Wave and QT Dispersion in Children with Inflammatory Bowel Disease in Remission

    Science.gov (United States)

    Yılmaz, Nuh; Kutluk, Günsel; Dedeoğlu, Reyhan; Öztarhan, Kazım; Tulunoğlu, Aras; Şap, Fatih

    2017-01-01

    Objectives. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) with unclear underlying aetiologies. Severe cardiac arrhythmias have been emphasised in a few studies on adult IBD patients. This study aimed to investigate the alteration of the P-wave and QT interval dispersion parameters to assess the risk of atrial conduction and ventricular repolarisation abnormalities in pediatric IBD patients. Patients and Methods. Thirty-six IBD patients in remission (UC: 20, CD: 16) aged 3–18 years and 36 age- and sex-matched control patients were enrolled in the study. Twelve-lead electrocardiograms were used to determine durations of P-wave, QT, and corrected QT (QTc) interval dispersion. Transthoracic echocardiograms and 24-hour rhythm Holter recordings were obtained for both groups. Results. The P-wave dispersion, QT dispersion, and QTc interval dispersion (Pdisp, QTdisp, and QTcdisp) were significantly longer in the patient group. The mean values of Pminimum, Pmaximum, and QTcminimum were significantly different between the two groups. The echocardiography and Holter monitoring results were not significantly different between the groups. Furthermore, no differences in these parameters were detected between the CD and UC groups. Conclusion. Results suggest that paediatric IBD patients may carry potential risks for serious atrial and ventricular arrhythmias over time even during remission.

  20. Long term follow-up of remission patients in adult acute leukemia.

    Science.gov (United States)

    Gerecke, D; Kress, M; Hirschmann, W D

    1983-10-03

    31 adults suffering from acute leukemia were followed for a period of more than 5 years after achieving complete remission. Maintenance chemotherapy consisted of antimetabolite treatment (mercaptopurine + methotrexate) as well as COAP reinduction every 3 months. Chemotherapy was stopped if the first complete remission lasted for 3 years ("long term remission"). This was the case in 8 out of 31 remission patients (26%). Analysis of hematological parameters at diagnose for long term remission patients revealed that the initial leukocyte count was of prognostic significance.

  1. Persistent self-consciousness about facial appearance, measured with the Derriford appearance scale 59, in patients after long-term biochemical remission of acromegaly.

    Science.gov (United States)

    Roerink, S H P P; Wagenmakers, M A E M; Wessels, J F; Sterenborg, R B T M; Smit, J W; Hermus, A R M M; Netea-Maier, R T

    2015-06-01

    Acromegaly is associated with impaired quality of life (QoL) and causes anatomical disproportions, which may contribute to the decreased QoL after successful treatment. The Derriford appearance scale 59 (DAS59) is a questionnaire measuring psychological distress and disruptions to everyday life associated with self-consciousness of appearance. Investigate the psychological distress and dysfunction related to self-consciousness about appearance and its effect on QoL in patients in long-term remission of acromegaly. Patients (>18 years old) treated for acromegaly at the Department of Endocrinology of the Radboud University Medical Center Nijmegen were invited to participate. A gender-, age- and body mass index matched control group was provided by the patients themselves. Participants were asked to complete the modified DAS59-, research and development 36- (RAND-36), acromegaly quality of life questionnaire (AcroQoL) and a sociodemographic questionnaire. Differences between patient- and control groups and correlations between questionnaire scores and clinical characteristics collected from medical records were analyzed. Questionnaire scores. Of the 120 respondents, 73 agreed to participate [all cured or under biochemical control, median remission time 10.5 years (range 2.3-43.6 years)]. Of these, 34 (46.6%) reported self-consciousness about their appearance. Twenty-nine of these patients (85.3%) pointed out their face to be a prominent source of self-consciousness. Fifty-seven matched control subjects were included as well. Significant correlations were found between the scores of the DAS59 and the AcroQoL, RAND-36 and VAS in patients. Even after long-term remission of acromegaly, a large number of patients are self-conscious about their appearance, leading to psychological distress and disruptions to everyday life and decreased QoL. Facial features were the most important source of self-consciousness. This stresses the importance of addressing self-consciousness of

  2. Residuals in post-chemotherapy, non-depressed patients with leukemia that is in remission

    Directory of Open Access Journals (Sweden)

    Peterson K. Rachel

    2016-04-01

    Full Text Available Debate persists regarding the occurrence and etiology of neurocognitive deficits associated with the utilization of chemotherapeutic agents, commonly referred to as “chemobrain”. While some have previously attributed these features to other factors such as fatigue, emotional reactivity, etc., growing literature suggests that in fact chemotherapeutic agents may be the cause. Although research has investigated these deficits, greater investigation is warranted. The current study investigated the presence of residual neurocognitive deficits in non-depressed patients post-chemotherapy with a history of leukemia that was in remission in comparison to healthy controls. Methods: participants included 16 individuals with a history of leukemia post-chemotherapy, in remission and without depression and 48 healthy controls. Participants were assessed using the WJ-III with data from the first seven subtests entered for analysis. A multivariate analysis of variance revealed significant differences existed between groups. By way of a discriminant function analysis, subtest/domain specific discrepancies were noted. Specifically, participants with a history of leukemia who were post-chemotherapy and without depression were found to perform significantly worse on visual-auditory learning, concept formations, and sound blending than did healthy controls. Findings are seen as additional support of the idea that neurocognitive deficits do in fact occur following chemotherapy. However, they are particularly of interest as they are seen even in the absence of emotional distress and outside the active treatment phase. Additional findings of importance and clinical relevance will be discussed.

  3. Maintenance of remission with infliximab in inflammatory bowel disease: Efficacy and safety long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the safety and efficacy of a longterm therapy with infliximab in Crohn's disease (CD) and ulcerative colitis (UC) patients retrospectively.METHODS: The medical charts of 50 patients (40 CD and 10 UC), who received after a loading dose of 3 infliximab infusions scheduled re-treatments every 8 wk as a maintenance protocol, were reviewed.RESULTS: Median (range) duration of treatment was 27 (4-64) mo in CD patients and 24.5 (6-46) mo in UC patients. Overall, 32 (80%) CD and 9 (90%) UC patients showed a sustained clinical response or remission throughout the maintenance period. Three CD patients shortened the interval between infusions. Eight (20%) CD patients and 1 UC patient underwent surgery for flare up of disease. Nine out of 29 CD and 4 out of 9 UC patients, who discontinued infliximab scheduled treatment, are still relapse-free after a median of 16 (5-30) and 6.5 (4-16) mo following the last infusion,respectively. Ten CD patients (25%) and 1 UC patient required concomitant steroid therapy during maintenance period, compared to 30 (75%) and 9 (90%) patients at enrolment. Of the 50 patients, 16 (32%) experienced at least 1 adverse event and 3 patients (6%) were diagnosed with cancer during maintenance treatment.CONCLUSION: Scheduled infliximab strategy is effective in maintaining long-term clinical remission both in CD and UC and determines a marked steroid sparing effect.Long-lasting remission was observed following infliximab withdrawal.

  4. Clinical efficacy and safety of an implantable cardioverter-defibrillator lead with a floating atrial sensing dipole

    DEFF Research Database (Denmark)

    Safak, Erdal; Schmitz, Dietmar; Konorza, Thomas;

    2013-01-01

    The concept of a single-lead implantable cardioverter-defibrillator (ICD), with a floating dipole, has been proven safe and functional.......The concept of a single-lead implantable cardioverter-defibrillator (ICD), with a floating dipole, has been proven safe and functional....

  5. Favorable effect of priming with granulocyte colony-stimulating factor in remission induction of acute myeloid leukemia restricted to dose escalation of cytarabine

    NARCIS (Netherlands)

    Pabst, Thomas; Vellenga, Edo; van Putten, Wim; Schouten, Harry C.; Graux, Carlos; Vekemans, Marie-Christiane; Biemond, Bart; Sonneveld, Peter; Passweg, Jakob; Verdonck, Leo; Legdeur, Marie-Cecile; Theobald, Matthias; Jacky, Emanuel; Bargetzi, Mario; Maertens, Johan; Ossenkoppele, Gert Jan; Lowenberg, Bob

    2012-01-01

    The clinical value of chemotherapy sensitization of acute myeloid leukemia (AML) with G-CSF priming has remained controversial. Cytarabine is a key constituent of remission induction chemotherapy. The effect of G-CSF priming has not been investigated in relationship with variable dose levels of cyta

  6. Defining Treatment Response and Remission in Obsessive-Compulsive Disorder: A Signal Detection Analysis of the Children's Yale-Brown Obsessive Compulsive Scale

    Science.gov (United States)

    Storch, Eric A.; Lewin, Adam B.; De Nadai, Alessandro S.; Murphy, Tanya K.

    2010-01-01

    Objective: To examine the optimal Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) percent reduction cutoffs for predicting treatment response and clinical remission among children and adolescents with obsessive-compulsive disorder (OCD). Method: Youth with OCD (N = 109; range 7 to 19 years) received 14 sessions of weekly or intensive…

  7. Analysis of associated factors for remission and relapse in proliferative and membranous lupus nephritis patients: a 4-year follow-up study

    Institute of Scientific and Technical Information of China (English)

    戚超君

    2014-01-01

    Objective To explore the related factors of remission and relapse in lupus nephritis(LN)patients.Methods A retrospective study was conducted for proliferation and membrane LN patients diagnosed from 2003 to 2010.Their clinical,laboratory and pathological parameters were collected.According to the response to treatment,they were divided into 3

  8. Phase III trial of intraperitoneal therapy with yttrium-90-labeled HMFG1 murine monoclonal antibody in patients with epithelial ovarian cancer after a surgically defined complete remission.

    NARCIS (Netherlands)

    Verheijen, R.H.; Massuger, L.F.A.G.; Benigno, B.B.; Epenetos, A.A.; Lopes, A.; Soper, J.T.; Markowska, J.; Vyzula, R.; Jobling, T.; Stamp, G.; Spiegel, G.; Thurston, D.; Falke, T.; Lambert, J.; Seiden, M.V.

    2006-01-01

    PURPOSE: This was a multinational, open-label, randomized phase III trial comparing yttrium-90-labeled murine HMFG1 (90Y-muHMFG1) plus standard treatment versus standard treatment alone in patients with epithelial ovarian cancer (EOC) who had attained a complete clinical remission after

  9. Concordance between actual and pharmacogenetic predicted desvenlafaxine dose needed to achieve remission in major depressive disorder: a 10-week open-label study

    Science.gov (United States)

    Müller, Daniel J.; Ng, Chee H.; Byron, Keith; Berk, Michael; Singh, Ajeet B.

    2017-01-01

    Background Pharmacogenetic-based dosing support tools have been developed to personalize antidepressant-prescribing practice. However, the clinical validity of these tools has not been adequately tested, particularly for specific antidepressants. Objective To examine the concordance between the actual dose and a polygene pharmacogenetic predicted dose of desvenlafaxine needed to achieve symptom remission. Materials and methods A 10-week, open-label, prospective trial of desvenlafaxine among Caucasian adults with major depressive disorder (n=119) was conducted. Dose was clinically adjusted and at the completion of the trial, the clinical dose needed to achieve remission was compared with the predicted dose needed to achieve remission. Results Among remitters (n=95), there was a strong concordance (Kendall’s τ-b=0.84, P=0.0001; Cohen’s κ=0.82, P=0.0001) between the actual and the predicted dose need to achieve symptom remission, showing high sensitivity (≥85%), specificity (≥86%), and accuracy (≥89%) of the tool. Conclusion Findings provide initial evidence for the clinical validity of a polygene pharmacogenetic-based tool for desvenlafaxine dosing. PMID:27779571

  10. Defining Treatment Response and Remission in Obsessive-Compulsive Disorder: A Signal Detection Analysis of the Children's Yale-Brown Obsessive Compulsive Scale

    Science.gov (United States)

    Storch, Eric A.; Lewin, Adam B.; De Nadai, Alessandro S.; Murphy, Tanya K.

    2010-01-01

    Objective: To examine the optimal Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) percent reduction cutoffs for predicting treatment response and clinical remission among children and adolescents with obsessive-compulsive disorder (OCD). Method: Youth with OCD (N = 109; range 7 to 19 years) received 14 sessions of weekly or intensive…

  11. A framework for remission in SLE : Consensus findings from a large international task force on definitions of remission in SLE (DORIS)

    NARCIS (Netherlands)

    van Vollenhoven, Ronald F.; Voskuyl, Alexandre E.; Bertsias, George K.; Aranow, Cynthia; Aringer, Martin; Arnaud, Laurent; Askanase, Anca; Balazova, Petra; Bonfa, Eloisa; Bootsma, Hendrika; Boumpas, Dimitrios T.; Bruce, Ian N.; Cervera, Ricard; Clarke, Ann; Coney, Cindy; Costedoat-Chalumeau, Nathalie; Czirjak, Laszlo; Derksen, Ronald; Doria, Andrea; Doerner, Thomas; Fischer-Betz, Rebecca; Fritsch-Stork, Ruth; Gordon, Caroline; Graninger, Winfried; Gyori, Noemi; Houssiau, Frederic A.; Isenberg, David A.; Jacobsen, Soren; Jayne, David; Kuhn, Annegret; Le Guern, Veronique; Lerstrom, Kirsten; Levy, Roger; Machado-Ribeiro, Francinne; Mariette, Xavier; Missaykeh, Jamil; Morand, Eric; Mosca, Marta; Inanc, Murat; Navarra, Sandra; Neumann, Irmgard; Olesinska, Marzena; Petri, Michelle; Rahman, Anisur; Rekvig, Ole Petter; Rovensky, Jozef; Shoenfeld, Yehuda; Smolen, Josef S.; Tincani, Angela; Urowitz, Murray; van Leeuw, Bernadette; Vasconcelos, Carlos; Voss, Anne; Werth, Victoria P.; Zakharova, Helena; Zoma, Asad; Schneider, Matthias; Ward, Michael

    Objectives Treat-to-target recommendations have identified `remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.

  12. Disappointing durable remission rates in complex Crohn's disease fistula.

    Science.gov (United States)

    Molendijk, Ilse; Nuij, Veerle J A A; van der Meulen-de Jong, Andrea E; van der Woude, C Janneke

    2014-11-01

    Despite potent drugs and surgical techniques, the treatment of perianal fistulizing Crohn's disease (CD) remains challenging. We assessed treatment strategies for perianal fistulizing CD and their effect on remission, response, and relapse. Patients with perianal fistulizing CD visiting the Erasmus MC between January 1, 1980 and January 1, 2000 were identified. Demographics, fistula characteristics, and received treatments aimed at the outcome of these strategies were noted. In total, 232 patients were identified (98 male; 42.2%). Median follow-up was 10.0 years (range, 0.5-37.5 yr). Complex fistulas were present in 78.0%. Medical treatment (antibiotics, steroids, immunosuppressants, and anti-tumor necrosis factor) commenced in 79.7% of the patients and in 53.2%, surgery (colectomy, fistulectomy, stoma, and rectum amputation) was performed. Simple fistulas healed more often than complex fistulas (88.2% versus 64.6%; P fistula healing rates in simple and complex fistula. Initially, healed fistulas recurred in 26.7% in case of simple fistulas and in 41.9% in case of complex fistulas (P = 0.051). Only 37.0% of the complex fistulas were in remission at the end of follow-up compared with 66.7% of the simple fistulas (P fistulas were in remission after conventional treatment strategies after a median follow-up of 10 years. Simple fistulas were more likely to heal than complex fistulas, and less of these healed fistulas relapsed. However, more than 3 quarters of the patients had complex perianal fistulas.

  13. Cluster headache attack remission with sphenopalatine ganglion stimulation

    DEFF Research Database (Denmark)

    Barloese, Mads C J; Jürgens, Tim P; May, Arne

    2016-01-01

    BACKGROUND: Cluster headache (CH) is a debilitating headache disorder with severe consequences for patient quality of life. On-demand neuromodulation targeting the sphenopalatine ganglion (SPG) is effective in treating the acute pain and a subgroup of patients experience a decreased frequency of CH......, range 699-847) after insertion of an SPG microstimulator. Remission periods (attack-free periods exceeding one month, per the ICHD 3 (beta) definition) occurring during the 24-month study period were characterized. Attack frequency, acute effectiveness, medication usage, and questionnaire data were...

  14. Live attenuated varicella vaccine in children with leukemia in remission.

    Science.gov (United States)

    Gershon, A A; Steinberg, S; Galasso, G; Borkowsky, W; Larussa, P; Ferrara, A; Gelb, L

    1984-09-01

    One-hundred-ninety-one children with acute leukemia in remission for at least one year were immunized with 1 or more doses of live attenuated varicella vaccine. All were susceptible to varicella prior to vaccination. The only significant side effect was mild to moderate rash, seen especially in children with maintenance chemotherapy temporarily suspended for one week before and one week after vaccination. Children with rash were at some risk (10%) to transmit vaccine virus to varicella susceptibles with whom they had close contact.

  15. Don't wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse.

    Science.gov (United States)

    Laudet, Alexandre B; Becker, Jeffrey B; White, William L

    2009-01-01

    Individuals who have developed a clinical dependence on drugs and/or alcohol often report that they sought help because they were "sick and tired of being sick and tired." Quality of life (QOL) remains the missing measurement in the addictions arena. The few studies conducted to date show that QOL is typically poor during active addiction and improves as a function of remission. An intriguing question bears on the role of QOL in subsequent remission status. Reasoning that higher life satisfaction may "increase the price" of future use and thus enhance the likelihood of sustained remission, this exploratory study tests the hypotheses that QOL satisfaction prospectively predicts sustained remission, and that motivational constructs mediate the association. Inner city residents (N = 289, 53.6% male, mean age 43) remitting from chronic and severe histories of dependence to crack and/or heroin were interviewed three times at yearly interval beginning in April 2003. Logistic regression findings generally support our hypotheses: Controlling for other relevant variables, baseline life satisfaction predicted remission status 1 and 2 years later and the association was partially mediated by motivation (commitment to abstinence) although the indirect effect did not reach statistical significance. Findings underline the importance of examining the role of QOL satisfaction in remission processes. Limitations of this exploratory study are discussed, including the use of a single-item global life satisfaction rating; suggestions for future studies are discussed including the need to embrace QOL as a bona fide clinical outcome and to use comprehensive standardized QOL measures that speak to individual dimensions of functioning. Implications are noted, especially the need for the addiction field to continue moving away from the pathology-focused model of care toward a broader model that embraces multiple dimensions of positive health as a key outcome.

  16. Treatment of periocular hyperpigmentation due to lead of kohl (surma by penicillamine: A single group non-randomized clinical trial

    Directory of Open Access Journals (Sweden)

    El Safoury Omar

    2009-01-01

    Full Text Available Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production. Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity. Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score. Results: Highly significant P values (0.000 were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040 was recorded as regard to the vertical length. Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day for its treatment.

  17. Disease-modifying antirheumatic drug-free sustained remission in rheumatoid arthritis: an increasingly achievable outcome with subsidence of disease symptoms.

    Science.gov (United States)

    Ajeganova, S; van Steenbergen, H W; van Nies, J A B; Burgers, L E; Huizinga, T W J; van der Helm-van Mil, A H M

    2016-05-01

    Disease-modifying antirheumatic drug (DMARD)-free sustained remission, the sustained absence of synovitis after cessation of DMARD therapy, is a relevant long-term outcome of rheumatoid arthritis (RA) if (1) its occurrence is promoted by treatment and (2) this status reflects resolution of symptoms and disability. This study investigated both items. 1007 patients with RA diagnosed between 1993 and 2011, included in the Leiden Early Arthritis Clinic, were studied on achieving DMARD-free sustained remission. Patients included in 1993-1995 were initially treated with non-steroidal anti-inflammatory drugs, in 1996-1998 mild DMARDs were started early, from 1999 onwards methotrexate was initiated promptly and from 2005 onwards disease activity score (DAS)-steered treatment was common. Remission rates were compared using Kaplan-Meier curves and Cox proportional regression. In total, 155 patients achieved DMARD-free sustained remission. Specific treatment strategies were significantly associated with achieving remission (p<0.001). Cox regression adjusted for anticitrullinated protein antibody/rheumatoid factor, swollen joint count, erythrocyte sedimentation rate, C-reactive protein revealed HRs for DMARD-free sustained remission of 1.13 (95% CI 0.48 to 2.64) in patients diagnosed in 1996-1998, 2.39 (1.07 to 5.32) in patients treated with early methotrexate (inclusion 1999-2004) and 3.72 (1.60 to 8.62) in those treated early with methotrexate and DAS-steered therapy (inclusion 2005-2011). At the time of remission, the Health Assessment Questionnaire was at the level of the general population (median 0.13, IQR 0-0.63). Also, patient-rated visual analogue scale (VAS) morning stiffness, fatigue, pain and disease activity were low (median (IQR) mm, 14 (2-27), 10 (0-47), 6 (0-20), 7 (0-20), respectively). More intensive treatment strategies increased the chance for DMARD-free sustained remission, indicating that RA chronicity can be influenced. Patients with RA achieving DMARD

  18. Remission of bronchial asthma after viral clearance in chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Norihiko Yamamoto; Kazumoto Murata; Takeshi Nakano

    2005-01-01

    A 53-year-old man with a history of blood transfusion at the age of 20 was admitted to our hospital because of liver dysfunction. He had bronchial asthma when he was 18 years old, which naturally resolved within 2 years. However, his bronchial asthma recurred at the age of 45 and was treated with oral theophylline. He was diagnosed as having chronic hepatitis C based on the histological and clinical findings, and then interferon (IFN) therapy was administered. The frequency of bronchial asthma attack was gradually decreasing after IFN therapy with marked improvement of hypereosinophilia. He achieved sustained viral response (SVR) and his bronchial asthma did not worsen even after the cessation of IFN. Hepatitis C virus (HCV) infection and IFN therapy were considered in the remission of asthma in this case. HCV infection could be the cause of bronchial asthma, especially in patients with late appearance of asthma.

  19. A Case Report on Juvenile Neuromyelitis Optica: Early Onset, Long Remission Period, and Atypical Treatment Response.

    Science.gov (United States)

    Elpers, Christiane; Gross, Catharina C; Fiedler, Barbara; Meuth, Sven G; Kurlemann, Gerhard

    2015-08-01

    Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease of the central nervous system and preferentially targets the optic nerves and spinal cord. NMO is rare in children and clinical course of the disease is highly variable as described in studies. Here, we present a case report of a young girl presenting with a rare course of pediatric NMO with an early disease onset at the age of 12 years, a relapse free interval of 4 years, evidence of NMO immunoglobulin G (IgG) and an unusual response against immunosuppressive therapy. The aim of this report is to highlight the potentially long remission period between relapses complicating proper diagnosis despite well defined diagnostic criteria. In addition, we want to encourage the use of rituximab in pediatric NMO, although larger cohorts are warranted to establish B cell depleting therapies in juvenile NMO.

  20. Fixed Size of Enlarged Calcified Lymph Nodes in Esophageal Adenocarcinoma despite Complete Remission

    Directory of Open Access Journals (Sweden)

    B.A. Grotenhuis

    2009-07-01

    Full Text Available Untreated malignant lymph nodes that are calcified are rare. Publications on such calcifications are restricted to case reports. We present a case of calcified lymph nodes in a patient with adenocarcinoma of the gastroesophageal junction that seemed to be nonresponsive to induction chemotherapy, as they did not decrease in size. However, on pathological examination of the resected lymph nodes no vital tumor cells could be detected anymore. Therefore, we hypothesize that a calcified lymph node is unable to shrink, even after adequate remission on induction chemotherapy. This should be taken into account when clinical decision-making depends on the change in size of an enlarged, calcified lymph node as a measure of treatment effect.

  1. Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone

    Directory of Open Access Journals (Sweden)

    R Hada

    2012-12-01

    We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy. Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma.

  2. Spontaneous Remission in an Older Patient with Relapsed FLT3 ITD Mutant AML

    Directory of Open Access Journals (Sweden)

    Pankit Vachhani

    2016-01-01

    Full Text Available Spontaneous remission (SR of acute myeloid leukemia (AML is a very rare phenomenon. AML characterized by FLT3 internal tandem duplication (FLT3 ITD is typically associated with an aggressive clinical course with rapid progression, relapse, and short overall survival in the absence of transplantation. We report here the first case of SR of FLT3 ITD mutant AML in the literature. Our patient was an elderly woman with relapsed NPM1 and FLT3 ITD mutant AML whose disease underwent SR for a brief duration without precipitating cause. We review the potential immune mechanisms underlying SR in AML and discuss the implications for novel immunotherapeutic approaches for FLT3 mutant AML.

  3. Eculizumab Induces Sustained Remission in a Patient With Refractory Primary Catastrophic Antiphospholipid Syndrome.

    Science.gov (United States)

    Zikos, Thomas A; Sokolove, Jeremy; Ahuja, Neera; Berube, Caroline

    2015-09-01

    Catastrophic antiphospholipid syndrome (CAPS) is fatal in approximately 44% of patients in whom the diagnosis is made, thus demonstrating the inadequacy of current medical therapy. In this report, we discuss a 47-year-old man with a known history of primary antiphospholipid syndrome, who presented with CAPS after undergoing cholecystectomy and a treatment-refractory early relapse after development of colitis. Given the potential therapeutic efficacy of complement inhibition in antiphospholipid syndrome, the patient was administered eculizumab, a terminal complement inhibitor. Progressive clinical improvement and laboratory improvement were observed upon initiation of eculizumab. He has remained in remission for over 16 months of follow-up while on eculizumab. In conclusion, this case represents successful use of eculizumab for the treatment of primary CAPS.

  4. Acute myelomonocytic leukaemia with short-term spontaneous remission in a cat.

    Science.gov (United States)

    Mylonakis, M E; Petanides, T A; Valli, V E; Vernau, W; Koytinas, A F; Michael, R S

    2008-06-01

    A 2-year-old, spayed female domestic shorthair cat was referred with a history of anorexia and depression of 1 week duration. On physical examination, the cat was lethargic and febrile, with splenomegaly, anisocoria and ulcerative stomatitis. A complete blood count (CBC) and a biochemistry profile showed leukocytosis, numerous blast cells in the peripheral blood, thrombocytopenia, hyperglobulinaemia and a positive test for feline leukaemia virus antigen. A diagnosis of acute myelomonocytic leukaemia was made on the basis of the results of bone marrow cytology, histopathology, and immunochemistry (CD3, CD79a, lysozyme, and myeloperoxidase) tests. Following an unexpected 1-month period of clinical and clinicopathological remission without chemotherapy, the cat relapsed and died 1 week later.

  5. Epidermal growth factor enemas for induction of remission in left-sided ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Hugo Nodarse-Cuní

    2013-03-01

    Full Text Available Introduction: ulcerative colitis is a little known chronic inflammatory disease in colonic mucosa. The positive effect of epidermal growth factor was shown in a previous report, with enema use for treatment of mild to moderate left-sided manifestation of the disease. This evidence provided the basis for evaluating the efficacy and safety profile of a viscous solution of this product. Methods: thirty-one patients were randomized to three groups for daily medications during 14 days. Twelve received one 10 mg enema of epidermal growth factor dissolved in 100 mL of viscous solution whereas nine were treated with placebo enema; both groups also received 1.2 g of oral mesalamine per day. The other group included ten patients with 3 g / 100 mL of mesalamine enema. Primary end point was clinical responses after two weeks of treatment, defined as a decreased of, at least three points from baseline, the Disease Activity Index and endoscopic or histological evidences of improvement. Results: remission of disease was observed in all patients in the epidermal growth factor group, and six in both, mesalamine enema and placebo group. All the comparisons between groups showed statistically significant superiority for epidermal growth factor, the only product with significant reduction in disease activity index as well as the presence and intensity of digestive symptoms in patients after treatment. None adverse event was reported. Conclusions: the results agree with previous molecular and clinical evidences, indicating that the epidermal growth factor is effective to reduce disease activity and to induce remission. A new study involving more patients should be conducted to confirm the efficacy of the epidermal growth factor enemas.

  6. Frontal white matter anisotropy and antidepressant remission in late-life depression.

    Directory of Open Access Journals (Sweden)

    Warren D Taylor

    Full Text Available INTRODUCTION: Neuroanatomic features associated with antidepressant treatment outcomes in older depressed individuals are not well established. This study used diffusion tensor imaging to examine frontal white matter structure in depressed subjects undergoing a 12-week trial of sertraline. We hypothesized that remission would be associated with higher frontal anisotropy measures, and failure to remit with lower anisotropy. METHODS: 74 subjects with Major Depressive Disorder and age 60 years or older were enrolled in a twelve-week open-label trial of sertraline and completed clinical assessments and 1.5T magnetic resonance brain imaging. The apparent diffusion coefficient (ADC and fractional anisotropy (FA were measured in regions of interest placed in the white matter of the dorsolateral prefrontal cortex, anterior cingulate cortex, and corpus callosum. Differences in ADC and FA values between subjects who did and did not remit to treatment over the study period were assessed using generalized estimating equations, controlling for age, sex, medical comorbidity and baseline depression severity. RESULTS: Subjects who did not remit to sertraline exhibited higher FA values in the superior frontal gyri and anterior cingulate cortices bilaterally. There were no statistically significant associations between ADC measures and remission. CONCLUSIONS: Failure to remit to sertraline is associated with higher frontal FA values. Functional imaging studies demonstrate that depression is characterized by functional disconnection between frontal and limbic regions. Those individuals where this disconnection is related to structural changes as detected by DTI may be more likely to respond to antidepressants. TRIAL REGISTRATION: ClinicalTrials.gov NCT00339066.

  7. Differential expression of NK receptors CD94 and NKG2A by T cells in rheumatoid arthritis patients in remission compared to active disease.

    Directory of Open Access Journals (Sweden)

    Ceara E Walsh

    Full Text Available OBJECTIVE: TNF inhibitors (TNFi have revolutionised the treatment of rheumatoid arthritis (RA. Natural killer (NK cells and Natural Killer Cell Receptor+ T (NKT cells comprise important effector lymphocytes whose activity is tightly regulated through surface NK receptors (NKRs. Dysregulation of NKRs in patients with autoimmune diseases has been shown, however little is known regarding NKRs expression in patients with TNFi-induced remission and in those who maintain remission vs disease flare following TNFi withdrawal. METHODS: Patients with RA were recruited for this study, (i RA patients in clinical remission following a minimum of one year of TNFi therapy (n = -15; (2 Active RA patients, not currently or ever receiving TNFi (n = 18; and healthy control volunteers (n = 15. Patients in remission were divided into two groups: those who were maintained on TNFi and those who withdrew from TNFi and maintained on DMARDS. All patients underwent full clinical assessment. Peripheral blood mononuclear cells were isolated and NKR (CD94, NKG2A, CD161, CD69, CD57, CD158a, CD158b expression on T-(CD3+CD56-, NK-(CD3-CD56+ and NKT-(CD3+CD56+ cells was determined by flow cytometry. RESULTS: Following TNFi withdrawal, percentages and numbers of circulating T cells, NK cells or NKT cell populations were unchanged in patients in remission versus active RA or HCs. Expression of the NKRs CD161, CD57, CD94 and NKG2A was significantly increased on CD3+CD56-T cells from patients in remission compared to active RA (p<0.05. CD3+CD56-T cell expression of CD94 and NKG2A was significantly increased in patients who remained in remission compared with patients whose disease flared (p<0.05, with no differences observed for CD161 and CD57. CD3+CD56- cell expression of NKG2A was inversely related to DAS28 (r = -0.612, p<0.005. CONCLUSION: High CD94/NKG2A expression by T cells was demonstrated in remission patients following TNFi therapy compared to active RA

  8. Remission induction and maintenance effect of probiotics on ulcerative colitis: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To evaluate the induction of remission and main-tenance effects of probiotics for ulcerative colitis.METHODS: Information was retrieved from MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The induction of remission and promotion of mainte-nance were compared between probiotics treatment and non-probiotics treatment in ulcerative colitis.RESULTS: Thirteen randomized controlled studies met the selection criteria. Seven studies evaluated the remission rate, and eight studies estimated the re...

  9. Remission of proteinuria indicates good prognosis in patients with diffuse proliferative lupus nephritis.

    Science.gov (United States)

    Koo, H S; Kim, S; Chin, H J

    2016-01-01

    Proteinuria is a well-known risk factor for the progression of renal dysfunction in chronic kidney disease; however, its importance for estimating the prognosis of lupus nephritis requires verification. Korean adult patients with renal biopsy-diagnosed diffuse proliferative lupus nephritis who had undergone three or more consecutive urine protein to creatinine ratio or urine dipstick tests within six months after renal biopsy were enrolled. The cumulative risks, predictors, and outcomes of proteinuric remission and flare were evaluated. This study included 26 men and 167 women with a mean age at renal biopsy of 31.2 ± 9.8 years. Eighty-two (42.5%) patients experienced proteinuric remission during the follow-up period. During a mean follow-up of 157.9 ± 69.5 months, among patients who achieved proteinuric remission, one died, one developed end-stage renal disease (ESRD), and two had composite outcomes; among patients without remission, nine died, 24 developed ESRD, and 30 had composite outcomes. Patients who achieved proteinuric remission had a 0.089-fold risk (95% CI: 0.011-0.736) of mortality, 0.110-fold risk (95% CI: 0.013-0.904) of incident ESRD, and 0.210-fold risk (95% CI: 0.048-0.920) of a composite outcome compared to patients without remission. Among the 82 patients who achieved proteinuric remission, 59 (72.0%) experienced at least one proteinuria flare; however, relapse did not correlate with the incidence of outcomes. In conclusion, proteinuric remission is an independent predictive prognostic marker of good renal survival and mortality, regardless of the interval from biopsy to remission, recurrence of proteinuria after remission, renal function status at remission, or hematuria remission.

  10. Review article: remission rates achievable by current therapies for inflammatory bowel disease

    OpenAIRE

    2011-01-01

    Abstract Background and Aim: To review remission rates with current medical treatments for inflammatory bowel disease (IBD). Methods We searched MEDLINE (source PUBMED, 1966 to January, 2011). Results Induction and maintenance of remission was observed in 20% (range, 9-29.5%) and 53% (range, 36.8-59.6%) of ulcerative colitis (UC) patients treated with oral 5-ASA derivatives. Induction of remission was noted in 52% (range, 48-58%) of Crohn?s disease (CD) patients and 54% of UC...

  11. Difficulties in diagnosis and treatment of adult-onset Still's disease concurrent with pericardial effusion as a leading clinical manifestation

    Directory of Open Access Journals (Sweden)

    V. Yu. Myachikova

    2016-01-01

    Full Text Available The paper considers a case of adult-onset Still's disease that occurred as acute pericarditis, two-spike hectic fever, and neutrophilic leukocytosis in a young man. It was difficult to establish a correct diagnosis because there were no characteristic clinical symptoms of Still's disease, such as salmon colored rash, arthralgia, and sore throat. The diagnosis of adult-onset Still's disease was verified on the basis of the classification criteria described by M. Yamaguchi et al. The special feature of the clinical case was the development of steroid resistance and the effective use of a combination of the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, given intravenously dropwise once every four weeks and methotrexate (15 mg/week orally. During this treatment, a sustained clinical and laboratory response was achieved, which could reduce the dose of glucocorticoids to the maintaining one.

  12. Prediction of remission and low disease activity in disease-modifying anti-rheumatic drug-refractory patients with rheumatoid arthritis treated with golimumab

    Science.gov (United States)

    Kutzbach, Abraham Garcia; Amital, Howard; Pavelka, Karel; Lazaro, María Alicia; Moots, Robert J.; Wollenhaupt, Jürgen; Zerbini, Cristiano A. F.; Louw, Ingrid; Combe, Bernard; Beaulieu, Andre; Schulze-Koops, Hendrik; Dasgupta, Bhaskar; Fu, Bo; Huyck, Susan; Weng, Haoling H.; Govoni, Marinella; Durez, Patrick

    2016-01-01

    Objective. To create a tool to predict probability of remission and low disease activity (LDA) in patients with RA being considered for anti-TNF treatment in clinical practice. Methods. We analysed data from GO-MORE, an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ⩾3.2) despite DMARD therapy. Patients received 50 mg s.c. golimumab (GLM) once monthly for 6 months. In secondary analyses, regression models were used to determine the best set of baseline factors to predict remission (DAS28-ESR <2.6) at month 6 and LDA (DAS28-ESR ⩽3.2) at month 1. Results. In 3280 efficacy-evaluable patients, of 12 factors included in initial regression models predicting remission or LDA, six were retained in final multivariable models. Greater likelihood of LDA and remission was associated with being male; younger age; lower HAQ, ESR (or CRP) and tender joint count (or swollen joint count) scores; and absence of comorbidities. In models predicting 1-, 3- and 6-month LDA or remission, area under the receiver operating curve was 0.648–0.809 (R2 = 0.0397–0.1078). The models also predicted 6-month HAQ and EuroQoL-5-dimension scores. A series of matrices were developed to easily show predicted rates of remission and LDA. Conclusion. A matrix tool was developed to show predicted GLM treatment outcomes in patients with RA, based on a combination of six baseline characteristics. The tool could help provide practical guidance in selection of candidates for anti-TNF therapy. PMID:27114562

  13. Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study

    Directory of Open Access Journals (Sweden)

    Haynes Virginia S

    2012-12-01

    Full Text Available Abstract Background Little is known about the long-term outcomes for patients with schizophrenia who fail to achieve symptomatic remission. This post-hoc analysis of a 3-year study compared the costs of mental health services and functional outcomes between individuals with schizophrenia who met or did not meet cross-sectional symptom remission at study enrollment. Methods This post-hoc analysis used data from a large, 3-year prospective, non-interventional observational study of individuals treated for schizophrenia in the United States conducted between July 1997 and September 2003. At study enrollment, individuals were classified as non-remitted or remitted using the Schizophrenia Working Group Definition of symptom remission (8 core symptoms rated as mild or less. Mental health service use was measured using medical records. Costs were based on the sites’ medical information systems. Functional outcomes were measured with multiple patient-reported measures and the clinician-rated Quality of Life Scale (QLS. Symptoms were measured using the Positive and Negative Syndrome Scale (PANSS. Outcomes for non-remitted and remitted patients were compared over time using mixed effects models for repeated measures or generalized estimating equations after adjusting for multiple baseline characteristics. Results At enrollment, most of the 2,284 study participants (76.1% did not meet remission criteria. Non-remitted patients had significantly higher PANSS total scores at baseline, a lower likelihood of being Caucasian, a higher likelihood of hospitalization in the previous year, and a greater likelihood of a substance use diagnosis (all p Conclusions In this post-hoc analysis of a 3-year prospective observational study, the failure to achieve symptomatic remission at enrollment was associated with higher subsequent healthcare costs and worse functional outcomes. Further examination of outcomes for schizophrenia patients who fail to achieve remission at

  14. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis.

    Science.gov (United States)

    Panunzi, Simona; De Gaetano, Andrea; Carnicelli, Annamaria; Mingrone, Geltrude

    2015-03-01

    To compare diabetes remission after bariatric surgery in subjects with body mass index (BMI) of 35 kg/m2 or more or BMI of less than 35 kg/m to determine which predictors are best. BMI is currently the only selection criterion for bariatric surgery in diabetic subjects. Many studies have challenged BMI for predicting diabetes remission. Data sources were PubMed, Cochrane Library, and EMBASE databases from January 1980 to June 2013. The selected studies were randomized controlled trials, controlled clinical trials, or cohort studies with 10 or more patients per arm. Of 1437 screened articles, 94 studies were included with 94,579 patients undergoing surgical procedures (4944 with type 2 diabetes mellitus). Weight, BMI, glycated hemoglobin A1c, fasting glucose, and insulin were abstracted by 2 independent reviewers. The effect size was the percent diabetes remission. Meta-analysis was performed for BMI less than 35 kg/m2 (group 1) and BMI 35 kg/m2 or more (group 2). Diabetes remission was 72% [95% confidence interval (CI), 65-80] in group 1 and 71% (95% CI, 65-77) in group 2. Diabetes resolution was 89% (95% CI, 83-94) after biliopancreatic diversion, 77% (95% CI, 72-82) after Roux-en-Y bypass, 62% (95% CI, 46-79) after gastric banding, and 60% (95% CI, 51-70) after sleeve gastrectomy. The only significant predictor of glycated hemoglobin A1c reduction was waist circumference, lower baseline waist associating with higher reduction. Bariatric surgery determines similar diabetes remission rates in patients with BMI of 35 kg/m2 or more or BMI of less than 35 kg/m2. Baseline BMI is unrelated to diabetes remission. The association of baseline waist circumference with glycated hemoglobin A1c reduction is likely due to selection bias. Bariatric or metabolic effects of the surgical procedures appear independent, and different indices are needed to predict them.

  15. Global methylation and promoter-specific methylation of the P16, SOCS-1, E-cadherin, P73 and SHP-1 genes and their expression in patients with multiple myeloma during active disease and remission.

    Science.gov (United States)

    Martínez-Baños, Déborah; Sánchez-Hernández, Beatríz; Jiménez, Guadalupe; Barrera-Lumbreras, Georgina; Barrales-Benítez, Olga

    2017-05-01

    Tumor suppressor gene promoter CpG island methylation is a well-recognized mechanism in cancer pathogenesis, but its role in multiple myeloma (MM) is controversial. The present study investigated the methylation status and expression of P16, suppressor of cytokine signaling 1 (SOCS-1), P73, E-cadherin and Src homology region 2 domain-containing phosphatase 1 (SHP-1), as well as global methylation in patients with MM during active disease and remission. Bone marrow samples were obtained from 43 patients at the Multiple Myeloma Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City, Mexico) during active disease and remission. Methylation-specific polymerase chain reaction and ELISA were performed on bisulfite-treated or untreated DNA to determine promoter-specific or genomic methylation, respectively. Gene expression was measured using reverse-transcription polymerase chain reaction. The results indicated that SOCS-1 methylation occurred more frequently during active disease than remission [29 vs. 3.2% (P=0.021)] and was associated with more advanced forms of the disease [international staging system (ISS) 3, 16.67% vs. ISS 1, 8.3% (P=0.037)]. SHP-1 methylation during active disease was associated with a lower probability of survival at 39-month follow up (median), 52.5 vs. 87.5% (P=0.025). The percentage of methylation was associated with active disease at remission, but this was not significant. Global hypomethylation at remission was a negative predictor factor for overall survival (OS). The results indicated that methylated P16, SOCS-1 and SHP-1 were associated with clinical variables of poor prognosis in MM, likewise the persistence of global hypomethylation at remission. The negative impact on OS of global hypomethylation at remission must be confirmed in a larger sample. Future studies are necessary to investigate whether patients with global hypermethylation at remission should receive more aggressive treatments to

  16. Ultrafest: A Novel Approach to Ultrasound in Medical Education Leads to Improvement in Written and Clinical Examinations

    Directory of Open Access Journals (Sweden)

    Langdorf, Mark I.

    2014-12-01

    Full Text Available Introduction: Our objective was to evaluate the effectiveness of hands-on training at a bedside ultrasound (US symposium (“Ultrafest” to improve both clinical knowledge and image acquisition skills of medical students. Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma (FAST US knowledge. Secondary outcome was improvement in image acquisition for either pulmonary or FAST. Methods: Prospective cohort study of 48 volunteers at “Ultrafest,” a free symposium where students received five contact training hours. Students were evaluated before and after training for proficiency in either pulmonary US or FAST. Proficiency was assessed by clinical knowledge through written multiple-choice exam, and clinical skills through accuracy of image acquisition. We used paired sample t-tests with students as their own controls. Results: Pulmonary knowledge scores increased by a mean of 10.1 points (95% CI [8.9-11.3], p<0.00005, from 8.4 to a posttest average of 18.5/21 possible points. The FAST knowledge scores increased by a mean of 7.5 points (95% CI [6.3-8.7] p<0.00005, from 8.1 to a posttest average of 15.6/ 21. We analyzed clinical skills data on 32 students. The mean score was 1.7 pretest and 4.7 posttest of 12 possible points. Mean improvement was 3.0 points (p<0.00005 overall, 3.3 (p=0.0001 for FAST, and 2.6 (p=0.003 for the pulmonary US exam. Conclusion: This study suggests that a symposium on US can improve clinical knowledge, but is limited in achieving image acquisition for pulmonary and FAST US assessments. US training external to official medical school curriculum may augment students’ education. [West J Emerg Med. 2015;16(1:143–148.

  17. Thalidomide induces complete remission of advanced hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Cheng-Hung Chien

    2014-06-01

    Full Text Available Hepatocellular carcinoma (HCC is one of the most prevalent human cancers in the world, but its prognosis is extremely poor. HCC is considered a hypervascular tumor. Thalidomide, which has been known to inhibit growth factor-induced neovascularization, is a convenient alternative to target therapy such as sorafenib. We report a 65-year-old male patient with alcoholic liver cirrhosis that was diagnosed having multiple HCCs during surveillance. The patient was assessed as inoperable and unsuited for transhepatic arterial chemoembolization or systemic chemotherapy. After discussing the therapeutic alternatives, he decided to receive low-dose thalidomide (100 mg daily therapy. Fortunately, follow-up liver biochemical tests, serum α-fetoprotein level, and dynamic computed tomography showed complete remission of the HCCs 4.5 months after thalidomide treatment and this was documented for more than 22 months without evidence of tumor recurrence.

  18. Complete remission of epileptic psychosis after temporal lobectomy: case report

    Directory of Open Access Journals (Sweden)

    Marchetti Renato Luiz

    2001-01-01

    Full Text Available We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS. After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

  19. An evaluation of the shielding effectiveness of lead aprons used in clinics for protection against ionising radiation from novel radioisotopes.

    Science.gov (United States)

    Deb, Pradip; Jamison, Robert; Mong, Lisa; U, Paul

    2015-07-01

    The purpose of this study is to evaluate the effectiveness of personal radiation shields currently worn in hospital and other diagnostic environments. This study was performed with four different radioisotopes; (18)F, (99m)Tc, (124)I and (131)I. (18)F results showed a decrease in dose with 0.5-mm Pb shielding but the reduction provided does not warrant its use clinically. (124)I testing demonstrated that dose enhancement can occur in greater shield thicknesses. PET isotope (124)I can be adequately shielded using 0.25-mm Pb equivalent aprons but any higher thickness increase the wearer's dose. As a result more shielding does not always equal more protection. The (131)I test showed that no dose reduction occurred, even when tested with up to 1.25-mm Pb equivalent shielding. Novel radioisotopes being used in the laboratory and clinic should be individually tested as each requires specific shielding testing.

  20. Magnetic resonance imaging tracking of ferumoxytol-labeled human neural stem cells: studies leading to clinical use.

    Science.gov (United States)

    Gutova, Margarita; Frank, Joseph A; D'Apuzzo, Massimo; Khankaldyyan, Vazgen; Gilchrist, Megan M; Annala, Alexander J; Metz, Marianne Z; Abramyants, Yelena; Herrmann, Kelsey A; Ghoda, Lucy Y; Najbauer, Joseph; Brown, Christine E; Blanchard, M Suzette; Lesniak, Maciej S; Kim, Seung U; Barish, Michael E; Aboody, Karen S; Moats, Rex A

    2013-10-01

    Numerous stem cell-based therapies are currently under clinical investigation, including the use of neural stem cells (NSCs) as delivery vehicles to target therapeutic agents to invasive brain tumors. The ability to monitor the time course, migration, and distribution of stem cells following transplantation into patients would provide critical information for optimizing treatment regimens. No effective cell-tracking methodology has yet garnered clinical acceptance. A highly promising noninvasive method for monitoring NSCs and potentially other cell types in vivo involves preloading them with ultrasmall superparamagnetic iron oxide nanoparticles (USPIOs) to enable cell tracking using magnetic resonance imaging (MRI). We report here the preclinical studies that led to U.S. Food and Drug Administration approval for first-in-human investigational use of ferumoxytol to label NSCs prior to transplantation into brain tumor patients, followed by surveillance serial MRI. A combination of heparin, protamine sulfate, and ferumoxytol (HPF) was used to label the NSCs. HPF labeling did not affect cell viability, growth kinetics, or tumor tropism in vitro, and it enabled MRI visualization of NSC distribution within orthotopic glioma xenografts. MRI revealed dynamic in vivo NSC distribution at multiple time points following intracerebral or intravenous injection into glioma-bearing mice that correlated with histological analysis. Preclinical safety/toxicity studies of intracerebrally administered HPF-labeled NSCs in mice were also performed, and they showed no significant clinical or behavioral changes, no neuronal or systemic toxicities, and no abnormal accumulation of iron in the liver or spleen. These studies support the clinical use of ferumoxytol labeling of cells for post-transplant MRI visualization and tracking.

  1. Mechanistic validation of a clinical lead stapled peptide that reactivates p53 by dual HDM2 and HDMX targeting.

    Science.gov (United States)

    Wachter, F; Morgan, A M; Godes, M; Mourtada, R; Bird, G H; Walensky, L D

    2016-10-10

    Hydrocarbon-stapled peptides that display key residues of the p53 transactivation domain have emerged as bona fide clinical candidates for reactivating the tumor suppression function of p53 in cancer by dual targeting of the negative regulators HDM2 and HDMX. A recent study questioned the mechanistic specificity of such stapled peptides based on interrogating their capacity to disrupt p53/HDM2 and p53/HDMX complexes in living cells using a new recombinase enhanced bimolecular luciferase complementation platform (ReBiL). Here, we directly evaluate the cellular uptake, intracellular targeting selectivity and p53-dependent cytotoxicity of the clinical prototype ATSP-7041. We find that under standard serum-containing tissue culture conditions, ATSP-7041 achieves intracellular access without membrane disruption, dose-dependently dissociates both p53/HDM2 and p53/HDMX complexes but not an unrelated protein complex in long-term ReBiL experiments, and is selectively cytotoxic to cancer cells bearing wild-type p53 by inducing a surge in p53 protein level. These studies underscore the importance of a thorough stepwise approach, including consideration of the time-dependence of cellular uptake and intracellular distribution, in evaluating and advancing stapled peptides for clinical translation.Oncogene advance online publication, 10 October 2016; doi:10.1038/onc.2016.361.

  2. Development of a Series of Kynurenine 3-Monooxygenase Inhibitors Leading to a Clinical Candidate for the Treatment of Acute Pancreatitis.

    Science.gov (United States)

    Walker, Ann L; Ancellin, Nicolas; Beaufils, Benjamin; Bergeal, Marylise; Binnie, Margaret; Bouillot, Anne; Clapham, David; Denis, Alexis; Haslam, Carl P; Holmes, Duncan S; Hutchinson, Jonathan P; Liddle, John; McBride, Andrew; Mirguet, Olivier; Mowat, Christopher G; Rowland, Paul; Tiberghien, Nathalie; Trottet, Lionel; Uings, Iain; Webster, Scott P; Zheng, Xiaozhong; Mole, Damian J

    2017-04-27

    Recently, we reported a novel role for KMO in the pathogenesis of acute pancreatitis (AP). A number of inhibitors of kynurenine 3-monooxygenase (KMO) have previously been described as potential treatments for neurodegenerative conditions and particularly for Huntington's disease. However, the inhibitors reported to date have insufficient aqueous solubility relative to their cellular potency to be compatible with the intravenous (iv) dosing route required in AP. We have identified and optimized a novel series of high affinity KMO inhibitors with favorable physicochemical properties. The leading example is exquisitely selective, has low clearance in two species, prevents lung and kidney damage in a rat model of acute pancreatitis, and is progressing into preclinical development.

  3. Tacrolimus improves proteinuria remission in adults with cyclosporine A-resistant or -dependent minimal change disease.

    Science.gov (United States)

    Xu, Dechao; Gao, Xiang; Bian, Rongrong; Mei, Changlin; Xu, Chenggang

    2017-03-01

    Cyclosporin A (CsA) is considered as an effective treatment option for steroid-resistant or-dependent patients with adult-onset minimal change disease (MCD). However, CsA resistance or dependence is also observed in these patients. Tacrolimus (TAC) is a calcineurin inhibitor that is potent in cytokine suppression. The authors aim to evaluate the efficacy and safety of TAC therapy in CsA-resistant and-dependent adult-onset MCD patients. Patients with adult-onset MCD were enrolled in our department from 2008 to 2012. All patients were demonstrated to be resistant to or dependent on CsA therapy. Prednisone (0.5 mg/kg per day) combined with TAC (0.05-0.1 mg/kg per day) were prescribed to these patients for at least 6 months. The primary outcome was complete or partial remission of proteinuria. Secondary outcomes included time required for complete or partial remission, adverse events, number of relapses, and TAC dosages. A total of 11 MCD patients were enrolled in this observational study. The numbers of patients who presented with resistance to or dependence on CsA were 7 and 4, respectively. The total remission rate was 90.9% (10/11) with the complete remission rate 72.7% (8/11). Most remission patients achieved remission during the first 2 months of TAC therapy. Patients who presented with dependence on CsA had achieved complete remission with TAC therapy, while outcomes for CsA-resistant patients were four complete remissions, two partial remissions and one resistance. The adverse events were observed in this study included infection, diarrhoea, and worsened hypertension. Five patients who had remission experienced relapse. Tacrolimus improves proteinuria remission in adults with CsA-resistant or -dependent MCD. © 2016 Asian Pacific Society of Nephrology.

  4. Predictors of sustained drug-free diabetes remission over 48 weeks following short-term intensive insulin therapy in early type 2 diabetes

    Science.gov (United States)

    Kramer, Caroline K; Zinman, Bernard; Choi, Haysook; Retnakaran, Ravi

    2016-01-01

    Objective In early type 2 diabetes (T2DM), short-term intensive insulin therapy (IIT) for 2–4 weeks can decrease insulin resistance, reduce glucagonemia, improve β-cell function, and even induce a remission of diabetes that can last up to 1 year in some patients. However, little is known about the predictors of such a sustained remission. Methods We evaluated data from the placebo arm of a double-blind randomized controlled trial in which patients with early T2DM (≤7 years duration) underwent 4 weeks of IIT (basal detemir, bolus aspart), followed by placebo therapy for 48 weeks (n=25). Participants underwent an oral glucose tolerance test every 12 weeks, enabling serial assessment of insulin sensitivity, α-cell response, and β-cell function. Diabetes remission was defined as A1c<6.5% on no medication for T2DM. Results At 48 weeks post-IIT, 56% of the participants remained in remission. Comparison of remitters to non-remitters revealed no differences in waist, body mass index, insulin sensitivity (Matsuda index), or glucagon profile, either at baseline or over 48 weeks. Compared to non-remitters, the remission group had lower baseline A1c (p=0.006) and better baseline β-cell function (Insulin Secretion-Sensitivity Index-2) (p=0.01) that was then sustained across 48 weeks post-IIT (p=0.006). On logistic regression analyses, however, shorter duration of diabetes supplanted baseline A1c (p=0.24) and β-cell function (p=0.19) as an independent predictor of remission (p=0.04). In particular, diabetes duration <2 years predicted persistence of remission (p=0.006). Conclusions The key determinant of the likelihood of inducing sustained drug-free diabetes remission with short-term IIT is early intervention, particularly within the first 2 years after diagnosis. Trial registration number ClinicalTrials.Gov NCT01270789; Post-results. PMID:27547422

  5. Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease

    Science.gov (United States)

    Shendi, Ali M.; Salama, Alan D.; Khosravi, Maryam; Connolly, John O.; Trompeter, Richard

    2016-01-01

    Abstract Aim Treatment of frequently relapsing or steroid‐dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long‐term efficacy and safety are still limited. Methods We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid‐dependent, biopsy‐proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re‐treatment. Biochemical and clinical parameters were monitored over an extended follow‐up period of up to 43 months. Results Median steroid‐free survival after RTX was 25 months (range 4–34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow‐up period. Conclusions Rituximab therapy is effective at maintaining prolonged steroid‐free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid‐dependent MCD. PMID:26860320

  6. [Effect of plasmacytoid dendritic cells activited by bacteria on spontaneous remission of leukemia].

    Science.gov (United States)

    Li, Juan; Zhang, Lian-Sheng; Chai, Ye; Zeng, Peng-Yun; Wu, Chong-Yang; Yue, Ling-Ling; Bai, Jun; Hao, Zheng-Dong; Hu, Wan-Li; Chen, Hui-Ling; Guo, Xiao-Jia

    2014-10-01

    Spontaneous remission (SR) of leukemia is a rare event in clinic, which possibly correlated with severe infection and sepsis, but its exact mechanism has not been confirmed. Plasmacytoid dendritic cells (pDC) and myeloid dendritic cells (mDC) play a key role in innate and adaptive immunity respectively. A patient with severe infection of staphylococcus aureus acquired completely spontaneous remission (SR), moreover a increased number of pDC were observed, suggesting that bacteria-activated pDC may play an important role in SR. This study was purposed to explore if the bacteria can stimulate pDC successfully and get a functional pDC. Both pDC and mDC were isolated from freshly collected, leukocyte-rich buffy coats from healthy blood donor and leukemic patient with SR by using MACS and FACS. The pDC were cultured in RPMI 1640 medium and were stimulated with different kinds of bacteria and the expression of CD40, CD86 and HLA-DR on the cell surface was analyzed by flow cytometry. The cytokine (IFN-α, IL-12, IFN-γ, IL-2, IL-4, IL-10) production was measured by using ELISA kits. The results showed that the stimulation with staphylococcus aureus and pseudomonas aeruginosa resulted in the maturation of pDC, which secrete a large number of IFN-α and promote the differentiation of naive CD4⁺ T cells to Th1 cells. The activated pDC expressed high level of CD40 and CD86 and showed higher T cell stimulatory capacities. It is concluded that staphylococcus aureus and pseudomonas aeruginosa can activate pDC, the activated pDC secrete high quantity of IFN-α. This result suggests that bacteria stimulated pDC may play a key role in SR of leukemia following severe infections.

  7. Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

    Directory of Open Access Journals (Sweden)

    W. Yao

    2015-01-01

    Full Text Available Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT. We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB], and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC dose was 4.07 (range 2.76-6.02×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days and had platelet counts of >20×109/L on median day +35 (range 17-70 days. Sixteen patients (61.5% experienced pre-engraftment syndrome (PES, and six (23.1% patients progressed to acute graft-versus-host disease (GVHD. The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74, 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS, disease-free survival (DFS, and non-relapse mortality (NRM rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

  8. Enhanced cartilage repair in 'healer' mice-New leads in the search for better clinical options for cartilage repair.

    Science.gov (United States)

    Fitzgerald, Jamie

    2017-02-01

    Adult articular cartilage has a poor capacity to undergo intrinsic repair. Current strategies for the repair of large cartilage defects are generally unsatisfactory because the restored cartilage does not have the same resistance to biomechanical loading as authentic articular cartilage and degrades over time. Recently, an exciting new research direction, focused on intrinsic cartilage regeneration rather than fibrous repair by external means, has emerged. This review explores the new findings in this rapidly moving field as they relate to the clinical goal of restoration of structurally robust, stable and non-fibrous articular cartilage following injury.

  9. Rapid Lead Screening Test

    Science.gov (United States)

    ... Vitro Diagnostics Tests Used In Clinical Care Rapid Lead Screening Test Share Tweet Linkedin Pin it More ... reducing the need for a follow-up visit. Lead Risk Links Centers for Disease Control and Prevention ( ...

  10. Just enough, but not too much interactivity leads to better clinical skills performance after a computer assisted learning module.

    Science.gov (United States)

    Kalet, A L; Song, H S; Sarpel, U; Schwartz, R; Brenner, J; Ark, T K; Plass, J

    2012-01-01

    Well-designed computer-assisted instruction (CAI) can potentially transform medical education. Yet little is known about whether specific design features such as direct manipulation of the content yield meaningful gains in clinical learning. We designed three versions of a multimedia module on the abdominal exam incorporating different types of interactivity. As part of their physical diagnosis course, 162 second-year medical students were randomly assigned (1:1:1) to Watch, Click or Drag versions of the abdominal exam module. First, students' prior knowledge, spatial ability, and prior experience with abdominal exams were assessed. After using the module, students took a posttest; demonstrated the abdominal exam on a standardized patient; and wrote structured notes of their findings. Data from 143 students were analyzed. Baseline measures showed no differences among groups regarding prior knowledge, experience, or spatial ability. Overall there was no difference in knowledge across groups. However, physical exam scores were significantly higher for students in the Click group. A mid-range level of behavioral interactivity was associated with small to moderate improvements in performance of clinical skills. These improvements were likely mediated by enhanced engagement with the material, within the bounds of learners' cognitive capacity. These findings have implications for the design of CAI materials to teach procedural skills.

  11. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics

    NARCIS (Netherlands)

    Wunderink, Lex; Nienhuis, Fokko J.; Sytema, Sjoerd; Wiersma, Durk

    2007-01-01

    The objective of this study was to examine the predictive validity of the remission criteria proposed by Andreasen et all in first-episode patients responding to antipsychotics. Antipsychotic responsive patients with first-episode schizophrenia showing symptom remission (n = 60) were compared with p

  12. No survival benefit associated with routine surveillance imaging for Hodgkin lymphoma in first remission

    DEFF Research Database (Denmark)

    Jakobsen, Lasse H; Hutchings, Martin; de Nully Brown, Peter

    2016-01-01

    The use of routine imaging for patients with classical Hodgkin lymphoma (HL) in complete remission (CR) is controversial. In a population-based study, we examined the post-remission survival of Danish and Swedish HL patients for whom follow-up practices were different. Follow-up in Denmark included...

  13. New definition for the partial remission period in children and adolescents with type 1 diabetes.

    Science.gov (United States)

    Mortensen, Henrik B; Hougaard, Philip; Swift, Peter; Hansen, Lars; Holl, Reinhard W; Hoey, Hilary; Bjoerndalen, Hilde; de Beaufort, Carine; Chiarelli, Francesco; Danne, Thomas; Schoenle, Eugen J; Aman, Jan

    2009-08-01

    OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual beta-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS A total of 275 patients aged peptide during a challenge was used as a measure of residual beta-cell function. RESULTS By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient -0.21, P peptide >300 pmol/l was used to define partial remission. The IDAA1C remission and 61 patients ended partial remission, for A1C remission and 53 ended, for a definition of insulin dose remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months. CONCLUSIONS A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual beta-cell function and has better stability compared with the conventional definitions.

  14. Live attenuated varicella vaccine. Efficacy for children with leukemia in remission.

    Science.gov (United States)

    Gershon, A A; Steinberg, S P; Gelb, L; Galasso, G; Borkowsky, W; LaRussa, P; Farrara, A

    1984-07-20

    One hundred ninety-one varicella-susceptible children with leukemia in remission were immunized with live attenuated varicella vaccine. There was serological evidence of an immune response in approximately 80% after one dose and in more than 90% after two doses. The major side effect was mild to moderate rash, seen especially in children with maintenance chemotherapy suspended for one week before and one week after vaccination. Children with rash had higher antibody titers than those without rash, but those with rash were also at risk (10%) to transmit vaccine virus to others. Twenty-two vaccinees subsequently had household exposures to varicella or zoster. The attack rate of clinical varicella in these vaccinees was 18%, significantly lower than the attack rate of approximately 90% in varicella-susceptible persons with household exposures. All cases of clinical illness were extremely mild, with an average of about 50 vesicles. The mild character of the illness was clearly different than varicella in unimmunized children receiving chemotherapy for leukemia. Varicella vaccine was approximately 80% effective in preventing clinical varicella in children with leukemia and completely effective in preventing severe varicella in this high-risk group.

  15. Evolving from Reactive to Proactive Medicine: Community Lead (Pb and Clinical Disparities in Pre- and Post-Katrina New Orleans

    Directory of Open Access Journals (Sweden)

    Howard W. Mielke

    2014-07-01

    Full Text Available In 2012 the U.S. Centers for Disease Control (CDC set the blood Pb reference value at ≥5 µg/dL. Clinical analysis of children’s blood Pb levels is the common way to diagnose environmental Pb contamination, and intervention ensues with education and household dust cleanup. Recent review indicates that education and household dust cleanup are not effective at reducing children’s Pb exposure. Here we review mapping environmental Pb and children’s blood Pb response as an alternative approach for proactive Pb dust intervention. New Orleans was divided into a high (≥100 mg/kg and low (<100 mg/kg soil Pb communities. The children’s blood Pb prevalence ≥5 µg/dL for the high and low Pb domains were 58.5% and 24.8% respectively pre-Katrina vs. 29.6% and 7.5% post-Katrina. Elevated soil Pb (mg/kg and consequently Pb loading (µg/square area permeates the high Pb domain and outdoor locations lack Pb dust safe play areas. The U.S. EPA 400 mg/kg soil Pb standard poses an outside Pb dust loading burden >37 times larger than allowed on interior residential floor environments. Environmental Pb dust is decreasing because of the transfer of large quantities of low Pb soil into selected communities. City-scale soil Pb mapping is an alternative diagnostic tool that provides information for planning proactive medicine to prevent clinical Pb exposure in the first place.

  16. Alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis.

    Science.gov (United States)

    Kump, Patrizia K; Gröchenig, Hans-Peter; Lackner, Stefan; Trajanoski, Slave; Reicht, Gerhard; Hoffmann, K Martin; Deutschmann, Andrea; Wenzl, Heimo H; Petritsch, Wolfgang; Krejs, Guenter J; Gorkiewicz, Gregor; Högenauer, Christoph

    2013-09-01

    In patients with ulcerative colitis (UC), alterations of the intestinal microbiota, termed dysbiosis, have been postulated to contribute to intestinal inflammation. Fecal microbiota transplantation (FMT) has been used as effective therapy for recurrent Clostridium difficile colitis also caused by dysbiosis. The aims of the present study were to investigate if patients with UC benefit from FMT and if dysbiosis can be reversed. Six patients with chronic active UC nonresponsive to standard medical therapy were treated with FMT by colonoscopic administration. Changes in the colonic microbiota were assessed by 16S rDNA-based microbial community profiling using high-throughput pyrosequencing from mucosal and stool samples. All patients experienced short-term clinical improvement within the first 2 weeks after FMT. However, none of the patients achieved clinical remission. Microbiota profiling showed differences in the modification of the intestinal microbiota between individual patients after FMT. In 3 patients, the colonic microbiota changed toward the donor microbiota; however, this did not correlate with clinical response. On phylum level, there was a significant reduction of Proteobacteria and an increase in Bacteroidetes after FMT. FMT by a single colonoscopic donor stool application is not effective in inducing remission in chronic active therapy-refractory UC. Changes in the composition of the intestinal microbiota were significant and resulted in a partial improvement of UC-associated dysbiosis. The results suggest that dysbiosis in UC is at least in part a secondary phenomenon induced by inflammation and diarrhea rather than being causative for inflammation in this disease.

  17. Comparison of Digital 12-Lead ECG and Digital 12-Lead Holter ECG Recordings in Healthy Male Subjects: Results from a Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

    Science.gov (United States)

    Wang, Duolao; Bakhai, Ameet; Arezina, Radivoj; Täubel, Jörg

    2016-11-01

    Electrocardiogram (ECG) variability is greatly affected by the ECG recording method. This study aims to compare Holter and standard ECG recording methods in terms of central locations and variations of ECG data. We used the ECG data from a double-blinded, placebo-controlled, randomized clinical trial and used a mixed model approach to assess the agreement between two methods in central locations and variations of eight ECG parameters (Heart Rate, PR, QRS, QT, RR, QTcB, QTcF, and QTcI intervals). A total of 34 heathy male subjects with mean age of 25.7 ± 4.78 years were randomized to receive either active drug or placebo. Digital 12-lead ECG and digital 12-lead Holter ECG recordings were performed to assess ECG variability. There are no significant differences in least square mean between the Holter and the standard method for all ECG parameters. The total variance is consistently higher for the Holter method than the standard method for all ECG parameters except for QRS. The intraclass correlation coefficient (ICC) values for the Holter method are consistently lower than those for the standard method for all ECG parameters except for QRS, in particular, the ICC for QTcF is reduced from 0.86 for the standard method to 0.67 for the Holter method. This study suggests that Holter ECGs recorded in a controlled environment are not significantly different but more variable than those from the standard method. © 2016 Wiley Periodicals, Inc.

  18. Beyond IgE—When Do IgE-Crosslinking and Effector Cell Activation Lead to Clinical Anaphylaxis?

    Directory of Open Access Journals (Sweden)

    Lars K. Poulsen

    2017-08-01

    Full Text Available Anaphylaxis in humans is inherently difficult to study due to the acuteness of symptoms and the lack of biomarkers serving as risk predictors. Most cases are related to IgE sensitizations to foods, insect venoms, and drugs with mastocytosis patients forming a smaller risk group. However, identifying the relatively small fraction of persons at risk has been exceedingly difficult. In this review, we propose to describe anaphylaxis in a broader context than defined by IgE sensitization alone. Exposure to a trigger, such as an allergen, may lead to anaphylaxis, but in particular, the internal dose sensed by the immune system needs to be established. Moreover, intrinsic patient factors as well as the specific circumstances of the exposure, i.e., the extrinsic factors, need to be thoroughly accounted for. More controversially, other triggers of anaphylaxis, such as increased sensitivity to or reduced catabolism of histamine (“histamine intolerance” or mast cell activation syndrome also named mast cell activation disorder have been suggested, but still with very limited epidemiological evidence that a significant proportion of the observed reactions are caused by these alleged conditions. Thus, when all conditions are considered, it seems as if IgE-mediated reactions are responsible for the vast majority of anaphylactic conditions.

  19. The role of beta-cell function and insulin sensitivity in the remission of type 2 diabetes after gastric bypass surgery.

    Science.gov (United States)

    Nannipieri, M; Mari, A; Anselmino, M; Baldi, S; Barsotti, E; Guarino, D; Camastra, S; Bellini, R; Berta, R D; Ferrannini, E

    2011-09-01

    Bariatric surgery can induce remission in a high proportion of severely obese patients with type 2 diabetes mellitus (T2DM). Our objective was to investigate predictors and mechanisms of surgery-induced diabetes remission. Forty-three morbidly obese subjects (body mass index = 45.6 ± 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic [normal glucose tolerance (NGT)], participated at a clinical research center. Patients underwent Roux-en-Y gastric bypass. Diabetes remission and β-cell function were evaluated. Subjects were tested before and 45 d and 1 yr after surgery. Weight decreased similarly in T2DM and NGT (-39 kg at 1 yr, P coefficient interval, 53) pmol/min · m(2) · mm vs. median, 100 (coefficient interval, 68) of NGT, P coefficient interval, 50] vs. median, 22[coefficient interval, 26] vs. median, 4[coefficient interval, 10] pmol/min · m(2) · mm) and, by logistic regression, was the only predictor of failure [odds ratio for bottom tertile = 7.9 (95% confidence interval = 1.2-51.9); P = 0.03]. In morbid obesity, Roux-en-Y gastric bypass causes rapid and profound metabolic adaptations; insulin sensitivity improves in proportion to the weight loss, and β-cell glucose sensitivity increases independently of weight loss. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of β-cell dysfunction.

  20. Proteomic signatures of infertile men with clinical varicocele and their validation studies reveal mitochondrial dysfunction leading to infertility

    Directory of Open Access Journals (Sweden)

    Ashok Agarwal

    2016-01-01

    Full Text Available To study the major differences in the distribution of spermatozoa proteins in infertile men with varicocele by comparative proteomics and validation of their level of expression. The study-specific estimates for each varicocele outcome were combined to identify the proteins involved in varicocele-associated infertility in men irrespective of stage and laterality of their clinical varicocele. Expression levels of 5 key proteins (PKAR1A, AK7, CCT6B, HSPA2, and ODF2 involved in stress response and sperm function including molecular chaperones were validated by Western blotting. Ninety-nine proteins were differentially expressed in the varicocele group. Over 87% of the DEP involved in major energy metabolism and key sperm functions were underexpressed in the varicocele group. Key protein functions affected in the varicocele group were spermatogenesis, sperm motility, and mitochondrial dysfunction, which were further validated by Western blotting, corroborating the proteomics analysis. Varicocele is essentially a state of energy deprivation, hypoxia, and hyperthermia due to impaired blood supply, which is corroborated by down-regulation of lipid metabolism, mitochondrial electron transport chain, and Krebs cycle enzymes. To corroborate the proteomic analysis, expression of the 5 identified proteins of interest was validated by Western blotting. This study contributes toward establishing a biomarker "fingerprint" to assess sperm quality on the basis of molecular parameters.

  1. Pituitary apoplexy causing spontaneous remission of acromegaly following long-acting octreotide therapy: a rare drug side effect or just a coincidence

    Science.gov (United States)

    Kumar, Sunil; Sharma, Shruti

    2016-01-01

    Pituitary apoplexy is characterized by abrupt onset of haemorrhage or non-haemorrhagic infarction of a pituitary adenoma. The clinical features include acute onset severe headache, visual field defects, meningeal irritation, ophthalmoplegia and hypopituitarism. The pituitary apoplexy may be clinically silent in ∼25% of patients. We report a case of acromegaly due to pituitary macroadenoma. The patient was started on long-acting octreotide therapy. On 3-month follow-up, the patient showed clinical and biochemical remission and the magnetic resonance imaging (MRI) of the brain showed subclinical haemorrhage and resolution of tumour. The octreotide therapy was stopped. On 6-month follow-up, the patient was still in remission and the MRI of brain revealed non-enhancing mixed intensities haemorrhagic and cystic areas of the pituitary gland. In our patient, whether spontaneous remission of acromegaly due to subclinical pituitary haemorrhage was coincidental or due to long-acting octreotide therapy is still a dilemma. We report this case because of rarity and clinical importance of this unusual occurrence. PMID:27123308

  2. Clinical predictors of the leading pathogens in human immunodeficiency virus-infected adults with community-onset bacteremia in the emergency department: The importance of transmission routes.

    Science.gov (United States)

    Lee, Ching-Chi; Chou, Yu-Ju; Lin, Jiun-Nong; Chu, Feng-Yuan; Tang, Hung-Jen; Lai, Chung-Hsu; Lin, Hsi-Hsun; Hung, Chien-Ching; Ko, Wen-Chien

    2016-12-18

    To investigate the clinical characteristics and pathogens of community-onset bacteremia among human immunodeficiency virus (HIV)-infected adults as well as to establish the clinical predictors of the major microorganisms. An observational cohort study was conducted retrospectively between January 2007 and December 2012. Demographic characteristics and pathogens determined from chart records were analyzed. Of the 121 eligible HIV adults with bacteremia, there was a male predominance (106 patients, 87.6%); elderly individuals (age ≥ 65 years) accounted for only 2.5% of the study population (3 patients). Of the total microorganisms isolated (n=123), Staphylococcus aureus (55, 44.7%) and Salmonella enterica (17, 13.8%) were the common pathogens. In a multivariate analysis, the leading two significant predictors of S. aureus infection were infective endocarditis (odds ratio, 11.49; p=0.001) and transmission risk with injection drug users (IDUs; odds ratio, 6.22; p=0.001). In addition, transmission risk with men who have sex with men (MSM; odds ratio, 37.49; p=0.001) was the leading clinical predictor of S. enterica infection. In further analyses, a strong linear-by-linear correlation between S. aureus infection and IDU (γ=0.94, p=0.02) as well as between S. enterica infection and MSM (γ=0.96, p=0.01) was evidenced. Focusing on the two key pathogens in HIV-infected adults with community-onset bacteremia, IDU was one of independent predictors associated with S. aureus infection, whereas MSM was the leading risk factor of S. enterica infection. Although the proposed predictive model of these pathogens has been not established, a scoring system involving the transmission risk of HIV may be of use for the early identification of these patients for clinicians. Copyright © 2017. Published by Elsevier B.V.

  3. The Health Innovations Scholars Program: A Model for Accelerating Preclinical Medical Students' Mastery of Skills for Leading Improvement of Clinical Systems.

    Science.gov (United States)

    Sweigart, Joseph R; Tad-Y, Darlene; Pierce, Read; Wagner, Emilie; Glasheen, Jeffrey J

    2016-07-01

    Dramatic changes in health care require physician leadership. Efforts to instill necessary skills often occur late in training. The Heath Innovations Scholars Program (HISP) provided preclinical medical students with experiential learning focused on process improvement. Students led initiatives to improve the discharge process for stroke patients. All students completed an aptitude survey and Quality Improvement Knowledge Assessment Test (QIKAT) before and after the program. Significant improvements occurred across subject areas of leadership (18.4%, P lead clinical systems improvement. © The Author(s) 2015.

  4. A multicentre trial of live attenuated varicella vaccine in children with leukaemia in remission.

    Science.gov (United States)

    Gershon, A A; Steinberg, S; Gelb, L; Galasso, G; Borkowsky, W; LaRussa, P; Ferrara, A

    1985-01-01

    Two hundred forty children with acute leukaemia in remission for at least 1 year were immunized with live attenuated varicella vaccine. All were susceptible to varicella before immunization. There was a seroconversion to varicella-zoster virus in approximately 85% after 1 dose, and in 97% after 2 doses. The major side effect was mild to moderate rash, seen mainly in children with maintenance chemotherapy suspended for 1 week before and 1 week after vaccination. Vaccinees with rash were at some risk (10%) to transmit vaccine virus to varicella susceptibles with whom they had close contact. Twenty-nine vaccinees were subsequently exposed to varicella in their households. The attack rate of clinical varicella in these vaccinees was 21%, which is significantly lower than the 80%-90% attack rate occurring in varicella susceptibles after household exposure. All these breakthrough cases of varicella were mild, even in leukaemics receiving chemotherapy. Varicella vaccine was approximately 80% effective in preventing clinical varicella in children with leukaemia and completely effective in preventing severe varicella in this high-risk group.

  5. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.

    Science.gov (United States)

    Isasi, Carlos; Colmenero, Isabel; Casco, Fernando; Tejerina, Eva; Fernandez, Natalia; Serrano-Vela, José I; Castro, Maria J; Villa, Luis F

    2014-11-01

    Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.

  6. High-risk childhood acute lymphoblastic leukemia in first remission treated with novel intensive chemotherapy and allogeneic transplantation.

    Science.gov (United States)

    Marshall, G M; Dalla Pozza, L; Sutton, R; Ng, A; de Groot-Kruseman, H A; van der Velden, V H; Venn, N C; van den Berg, H; de Bont, E S J M; Maarten Egeler, R; Hoogerbrugge, P M; Kaspers, G J L; Bierings, M B; van der Schoot, E; van Dongen, J; Law, T; Cross, S; Mueller, H; de Haas, V; Haber, M; Révész, T; Alvaro, F; Suppiah, R; Norris, M D; Pieters, R

    2013-07-01

    Children with acute lymphoblastic leukemia (ALL) and high minimal residual disease (MRD) levels after initial chemotherapy have a poor clinical outcome. In this prospective, single arm, Phase 2 trial, 111 Dutch and Australian children aged 1-18 years with newly diagnosed, t(9;22)-negative ALL, were identified among 1041 consecutively enrolled patients as high risk (HR) based on clinical features or high MRD. The HR cohort received the AIEOP-BFM (Associazione Italiana di Ematologia ed Oncologia Pediatrica (Italy)-Berlin-Frankfurt-Münster ALL Study Group) 2000 ALL Protocol I, then three novel HR chemotherapy blocks, followed by allogeneic transplant or chemotherapy. Of the 111 HR patients, 91 began HR treatment blocks, while 79 completed the protocol. There were 3 remission failures, 12 relapses, 7 toxic deaths in remission and 10 patients who changed protocol due to toxicity or clinician/parent preference. For the 111 HR patients, 5-year event-free survival (EFS) was 66.8% (±5.5) and overall survival (OS) was 75.6% (±4.3). The 30 patients treated as HR solely on the basis of high MRD levels had a 5-year EFS of 63% (±9.4%). All patients experienced grade 3 or 4 toxicities during HR block therapy. Although cure rates were improved compared with previous studies, high treatment toxicity suggested that novel agents are needed to achieve further improvement.

  7. Pathogenetic, Clinical, and Prognostic Features of Adult t(4;11)(q21;q23)/MLL-AF4 Positive B-Cell Acute Lymphoblastic Leukemia

    OpenAIRE

    Marchesi, F.; Girardi, K.; Avvisati, G.

    2011-01-01

    Translocation t(4;11)(q21;q23) leading to formation of MLL-AF4 fusion gene is found in about 10% of newly diagnosed B-cell acute lymphoblastic leukemia (ALL) in adult patients. Patients expressing this chromosomal aberration present typical biological, immunophenotypic, and clinical features. This form of leukemia is universally recognized as high-risk leukemia and treatment intensification with allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR) could b...

  8. Maintaining remission in ulcerative colitis--role of once daily extended-release mesalamine.

    Science.gov (United States)

    Oliveira, Lilliana; Cohen, Russell D

    2011-02-27

    The aminosalicylates (5-ASA; also referred to as mesalamine-based agents) are considered as first-line in the maintenance of remission of mild to moderate ulcerative colitis (UC). Traditionally these agents have required a large pill burden and multiple daily dosing regimens which may account for the low adherence rates, especially in patients in remission. Extended-release mesalamine is the first once daily mesalamine product approved by the Food and Drug Administration for the maintenance of UC remission. This review will examine the pharmacokinetics, dosing, efficacy, and safety data of extended-release mesalamine, and discuss the potential role of improving medication compliance and decreasing costs in UC maintenance.

  9. New definition for the partial remission period in children and adolescents with type 1 diabetes

    OpenAIRE

    Mortensen, H.B.; Hougaard, P.; Swift, P.; Hansen, L.; Holl, R. W.; Hoey, H; Bjoerndalen, H.; de Beaufort, Carine; Chiarelli, F.; Danne, T.; Schoenle, E J; Åman, J

    2009-01-01

    OBJECTIVE - To find a simple definition of partial remission in type 1 diabetes that reflects both residual β-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS - A total of 275 patients aged 300 pmol/l was used to define partial remission. The IDAA1C ≤9 had a significantly higher agreement (P < 0.001) with residual β-cell function than use of a definition of A1C ≤7.5%. Between 6 and 12 months after diagnosis, for IDAA1C ≤9 only 1 patient entered partial remission an...

  10. T cells expressing an anti-B-cell maturation antigen chimeric antigen receptor cause remissions of multiple myeloma.

    Science.gov (United States)

    Ali, Syed Abbas; Shi, Victoria; Maric, Irina; Wang, Michael; Stroncek, David F; Rose, Jeremy J; Brudno, Jennifer N; Stetler-Stevenson, Maryalice; Feldman, Steven A; Hansen, Brenna G; Fellowes, Vicki S; Hakim, Frances T; Gress, Ronald E; Kochenderfer, James N

    2016-09-29

    Therapies with novel mechanisms of action are needed for multiple myeloma (MM). B-cell maturation antigen (BCMA) is expressed in most cases of MM. We conducted the first-in-humans clinical trial of chimeric antigen receptor (CAR) T cells targeting BCMA. T cells expressing the CAR used in this work (CAR-BCMA) specifically recognized BCMA-expressing cells. Twelve patients received CAR-BCMA T cells in this dose-escalation trial. Among the 6 patients treated on the lowest 2 dose levels, limited antimyeloma activity and mild toxicity occurred. On the third dose level, 1 patient obtained a very good partial remission. Two patients were treated on the fourth dose level of 9 × 10(6) CAR(+) T cells/kg body weight. Before treatment, the first patient on the fourth dose level had chemotherapy-resistant MM, making up 90% of bone marrow cells. After treatment, bone marrow plasma cells became undetectable by flow cytometry, and the patient's MM entered a stringent complete remission that lasted for 17 weeks before relapse. The second patient on the fourth dose level had chemotherapy-resistant MM making up 80% of bone marrow cells before treatment. Twenty-eight weeks after this patient received CAR-BCMA T cells, bone marrow plasma cells were undetectable by flow cytometry, and the serum monoclonal protein had decreased by >95%. This patient is in an ongoing very good partial remission. Both patients treated on the fourth dose level had toxicity consistent with cytokine-release syndrome including fever, hypotension, and dyspnea. Both patients had prolonged cytopenias. Our findings demonstrate antimyeloma activity of CAR-BCMA T cells. This trial was registered to www.clinicaltrials.gov as #NCT02215967.

  11. Lead Poisoning

    Science.gov (United States)

    Lead is a metal that occurs naturally in the earth's crust. Lead can be found in all parts of our ... from human activities such as mining and manufacturing. Lead used to be in paint; older houses may ...

  12. Successful Renal Transplantation in a Patient with Behcet Disease and Hodgkin Lymphoma in Remission

    Directory of Open Access Journals (Sweden)

    Vural Taner YILMAZ

    2011-05-01

    Full Text Available Behcet's disease (BD is an inflammatory multisystemic disease characterized by perivascular inflammation and generally presents with recurrent oral and genital ulcers and uveitis. It is known that BD may also involve the kidneys. Amyloidosis, glomerulonephritis (crescentic, proliferative, IgA nephropathy, interstitial nephritis are commonly described renal lesions which may lead to end-stage renal disease (ESRD in BD. Immunosuppressive therapies used for the treatment of BD may cause malignant diseases (lymphoma, skin and solid organ malignancies, etc. The risk with azathioprin is especially high after 10 years of treatment. Cyclosporine, another immunosuppressive agent frequently used for treatment of BD, also has tumorigenic potential and is associated with renal toxicity and renal failure. Renal transplantation may be performed in patients with malignancies after a 2-5 year complete remission period, although it may differ according to the type of tumor. We report a case of end-stage renal disease and Hodgkin's lymphoma occurring after treatment with immunosuppressive medicine for BD. The patient was successfully treated with renal transplantation.

  13. Early Prediction of Acute Antidepressant Treatment Response and Remission in Pediatric Major Depressive Disorder

    Science.gov (United States)

    Tao, Rongrong; Emslie, Graham; Mayes, Taryn; Nakonezny, Paul; Kennard, Betsy; Hughes, Carroll

    2009-01-01

    The rate of symptom improvement during the early weeks of acute fluoxetine treatment is a good indicator of remission. This finding was made after evaluating the outcome of the fluoxetine treatment on 168 children and adults with depression.

  14. Remission of Maternal Depression: Relations to Family Functioning and Youth Internalizing and Externalizing Symptoms

    Science.gov (United States)

    Foster, Cynthia Ewell; Webster, Melissa C.; Weissman, Myrna M.; Pilowsky, Daniel J.; Wickramaratne, Priya J.; Talati, Ardesheer; Rush, A. John; Hughes, Carroll W.; Garber, Judy; Malloy, Erin; Cerda, Gabrielle; Kornstein, Susan G.; Alpert, Jonathan E.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Fava, Maurizio; King, Cheryl A.

    2009-01-01

    Family functioning and parenting were hypothesized to mediate the relation between remission of maternal depression and children's psychosocial adjustment. Participants were 114 mother-child dyads participating in the Sequenced Treatment Alternatives to Relieve Depression Child 3-month follow-up. All mothers had been diagnosed with major depressive disorder and were treated initially with citalopram; 33% of mothers experienced remission of depressive symptoms. Youth ranged in age from 7 to 17. Remission of maternal depression was associated with changes in children's reports of their mothers' warmth/acceptance, which in turn partially mediated the relation between maternal depression remission and youth internalizing symptoms, accounting for 22.9% of the variance. PMID:18991123

  15. New definition for the partial remission period in children and adolescents with type 1 diabetes

    DEFF Research Database (Denmark)

    Mortensen, Henrik B; Hougaard, Philip; Swift, Peter

    2009-01-01

    the definition of an insulin dose-adjusted A1C (IDAA1C) as A1C (percent) + [4 x insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C peptide >300 pmol/l was used to define partial remission. The IDAA1C ..., for a definition of insulin dose remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6......OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual beta-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS A total of 275 patients aged

  16. Effect of Psychosocial Skills Training on Functional Remission of Patients With Schizophrenia.

    Science.gov (United States)

    Uzdil, Nurcan; Tanrıverdi, Derya

    2015-09-01

    This study was conducted as a two-group pretest-posttest design to determine the effect of psychosocial skills training on functional remission levels of patients with schizophrenia. A total of 100 patients were divided into the training group (n = 50) and the control group (n = 50). The data were collected using a Personal Information Form and Functional Remission of General Schizophrenia (FROGS) scale. The 13-session training program was given in the form of face-to-face group training and 45- to 60-min sessions twice a week. Training was completed by five groups. Every group comprised of 9 to 12 individuals on average. The training group had higher scores significantly on functional remission levels compared with the control group after psychosocial skills training (p Psychosocial skills training has become considerably effective in increasing the functional remission levels of patients with schizophrenia.

  17. Lead Toxicity

    Science.gov (United States)

    ... including some imported jewelry. What are the health effects of lead? • More commonly, lower levels of lead in children over time may lead to reduced IQ, slow learning, Attention Deficit Hyperactivity Disorder (ADHD), or behavioral issues. • Lead also affects other ...

  18. Occupational lead poisoning

    OpenAIRE

    Ramírez, Augusto V; Médico del Trabajo. American College of Occupational and Environmental Medicine.

    2013-01-01

    Lead, a ubiquitous heavy metal, has been found in places as unlikely as Greenland’s fossil ice. Egyptians and Hebrews used it. In Spain, Phoenicians c. 2000 BC worked ores of lead. At the end of the XX century, occupational lead’s poisoning became a public health problem in developed countries. In non-developed countries occupational lead poisoning is still frequent. Diagnosis is directed to recognize lead existence at the labor environment and good clinical and occupational documentation. Di...

  19. Bipolar depression: the importance of being on remission Depressão bipolar: a importância da remissão

    Directory of Open Access Journals (Sweden)

    Fernando Kratz Gazalle

    2006-06-01

    Full Text Available OBJECTIVE: The aim of the present study is to compare quality of life among currently depressed, subsyndromal and remitted patients with bipolar disorder (BD and to assess whether the level of depression correlates with the scores of quality of life in BD patients. METHOD: Sixty bipolar outpatients diagnosed using the Structured Clinical Interview for DSM-IV who met criteria for diagnosis of BD type I, II or not otherwise specified (BD-NOS, and who were not currently on a manic or mixed episode were included. The main variables of interest were quality of life (QOL assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS. RESULTS: A linear trend test showed a dose response association between patients' current mood state and all domains of quality of life. Higher quality of life scores were found among remitted patients, followed by subsyndromal patients; depressed patients presented lower scores of quality of life, except for the social domain. The four domains of the WHOQOL scale correlated negatively with the HDRS. CONCLUSIONS: Our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.OBJETIVO: O objetivo deste estudo é o de comparar a qualidade de vida entre pacientes com transtorno bipolar que estão atualmente deprimidos, com depressão subsindrômica e com remissão de sintomas, e avaliar se o nível de depressão tem correlação com os escores de qualidade de vida em pacientes com transtorno bipolar. MÉTODO: Sessenta pacientes bipolares tratados ambulatorialmente, diagnosticados pela Entrevista Clínica Estruturada do DSM-IV, que preencheram critérios diagnósticos de transtorno bipolar tipo I, tipo II ou sem outra especificação (TB-SOE, e que não estavam atualmente em um episódio maníaco ou misto foram incluídos. As principais variáveis de interesse

  20. Long-lasting remission of type 1 diabetes following treatment with topiramate for generalized seizures.

    Science.gov (United States)

    Davalli, Alberto M; Perego, Carla; Folli, Franco B; Bosi, Emanuele

    2012-02-01

    We report a case of unusually long-lasting remission of type 1 diabetes (T1D). The patient, a Caucasian man, at the age of 43 years developed a ketotic diabetes, classified as type 1 based on clinical presentation and positivity for islet autoantibodies. Shortly after diabetes onset, oral topiramate was added to preexisting valproic acid for generalized seizures and maintained thereafter. Initial intensive insulin treatment was rapidly reduced to low doses (3 Units/day) maintained for a long time and then discontinued at month 55; fasting glucose and glycosylated hemoglobin were basically normalized at 58 months. An oral glucose tolerance test performed at month 53 showed an impaired fasting glucose (6.0 mmol/l) and a value slightly above the threshold for the diagnosis of diabetes at 2 h (11.2 mmol/l). We hypothesize that this unusually prolonged preservation of β-cell function might be ascribed to the concomitant therapy with topiramate, an antiepileptic agent with demonstrated efficacy as antidiabetic in type 2 diabetes (T2D). Topiramate should be further investigated as candidate agent for the preservation of β-cell function also in T1D.

  1. Remission induction and maintenance effect of probiotics on ulcerative colitis: A meta-analysis

    Science.gov (United States)

    Sang, Li-Xuan; Chang, Bing; Zhang, Wen-Liang; Wu, Xiao-Mei; Li, Xiao-Hang; Jiang, Min

    2010-01-01

    AIM: To evaluate the induction of remission and maintenance effects of probiotics for ulcerative colitis. METHODS: Information was retrieved from MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The induction of remission and promotion of maintenance were compared between probiotics treatment and non-probiotics treatment in ulcerative colitis. RESULTS: Thirteen randomized controlled studies met the selection criteria. Seven studies evaluated the remission rate, and eight studies estimated the recurrence rate; two studies evaluated both remission and recurrence rates. Compared with the non-probiotics group, the remission rate for ulcerative colitis patients who received probiotics was 1.35 (95% CI: 0.98-1.85). Compared with the placebo group, the remission rate of ulcerative colitis who received probiotics was 2.00 (95% CI: 1.35-2.96). During the course of treatment, in patients who received probiotics for less than 12 mo compared with the group treated by non-probiotics, the remission rate of ulcerative colitis was 1.36 (95% CI: 1.07-1.73). Compared with the non-probiotics group, the recurrence rate of ulcerative colitis patients who received probiotics was 0.69 (95% CI: 2.47-1.01). In the mild to moderate group who received probiotics, compared to the group who did not receive probiotics, the recurrence rate was 0.25 (95% CI: 0.12-0.51). The group who received Bifidobacterium bifidum treatment had a recurrence rate of 0.25 (95% CI: 0.12-0.50) compared with the non-probiotics group. CONCLUSION: Probiotic treatment was more effective than placebo in maintaining remission in ulcerative colitis. PMID:20397271

  2. Disability and Quality of Life of Subjects with Bipolar Affective Disorder in Remission

    OpenAIRE

    2016-01-01

    Background: Despite significant advances in pharmacological and psychological therapies for bipolar disorder, many people continue to have less than optimal outcomes, which are associated with significant disability and poor quality of life (QOL). This study aimed to assess the disability and QOL and factors associated with such suboptimal outcomes in subjects with bipolar disorder in remission. Methods: Consecutive patients diagnosed to have bipolar disorder in remission attending the Depart...

  3. Intraoperation haemorrhage into hypophysis adenoma as the cause of acromegaly remission

    Directory of Open Access Journals (Sweden)

    V N Azizyan

    2011-03-01

    Full Text Available In this article we describe a spontaneous remission of acromegaly of intraoperative bleeding, with subsequent hemorrhage into the tumor. The cases of spontaneous remission of acromegaly described in the literature have been associated mainly with hemorrhage or ischemic apoplexy pituitary adenoma without surgical intervention. Most often, both processes, especially hemorrhage are accompanied by the development of panhypopituitarism. Cases in which there was a normalization of only growth hormone isolated.

  4. Adherence predicts symptomatic and psychosocial remission in schizophrenia: Naturalistic study of patient integration in the community.

    Science.gov (United States)

    Bernardo, Miguel; Cañas, Fernando; Herrera, Berta; García Dorado, Marta

    Psychosocial functioning in patients with schizophrenia attended in daily practice is an understudied aspect. The aim of this study was to assess the relationship between symptomatic and psychosocial remission and adherence to treatment in schizophrenia. This cross-sectional, non-interventional, and multicenter study assessed symptomatic and psychosocial remission and community integration of 1,787 outpatients with schizophrenia attended in Spanish mental health services. Adherence to antipsychotic medication in the previous year was categorized as≥80% vs.<80%. Symptomatic remission was achieved in 28.5% of patients, and psychosocial remission in 26.1%. A total of 60.5% of patients were classified as adherent to antipsychotic treatment and 41% as adherent to non-pharmacological treatment. During the index visit, treatment was changed in 28.4% of patients, in 31.1% of them because of low adherence (8.8% of the total population). Adherent patients showed higher percentages of symptomatic and psychosocial remission than non-adherent patients (30.5 vs. 25.4%, P<.05; and 32 vs. 17%, P<.001, respectively). Only 3.5% of the patients showed an adequate level of community integration, which was also higher among adherent patients (73.0 vs. 60.1%, P<.05). Adherence to antipsychotic medication was associated with symptomatic and psychosocial remission as well as with community integration. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Remission of screen-detected metabolic syndrome and its determinants: an observational study

    Directory of Open Access Journals (Sweden)

    den Engelsen Corine

    2012-09-01

    Full Text Available Abstract Background Early detection and treatment of the metabolic syndrome may prevent diabetes and cardiovascular disease. Our aim was to assess remission of the metabolic syndrome and its determinants after a population based screening without predefined intervention in the Netherlands. Methods In 2006 we detected 406 metabolic syndrome cases (The National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III definition among apparently healthy individuals with an increased waist circumference. They received usual care in a primary care setting. After three years metabolic syndrome status was re-measured. We evaluated which baseline determinants were independently associated with remission. Results The remission rate among the 194 participants was 53%. Baseline determinants independently associated with a remission were the presence of more than three metabolic syndrome components (OR 0.46 and higher levels of waist circumference (OR 0.91, blood pressure (OR 0.98 and fasting glucose (OR 0.60. Conclusions In a population with screen-detected metabolic syndrome receiving usual care, more than half of the participants achieved a remission after three years. This positive result after a relatively simple strategy provides a solid basis for a nation-wide implementation. Not so much socio-demographic variables but a higher number and level of the metabolic syndrome components were predictors of a lower chance of remission. In such cases, primary care physicians should be extra alert.

  6. Stopping epilepsy treatment in seizure remission: Good or bad or both?

    Science.gov (United States)

    Schmidt, Dieter; Sillanpää, Matti

    2017-01-01

    To review the outcome of epilepsy after stopping antiepileptic drugs in remission. Stopping antiepileptic drugs (AEDs) in remission is routinely done in many patients. Although the consequences of an unexpected relapse seizure in the 2 years after stopping AEDs may cause anguish and social issues, the impact on the long term seizure outlook of the epilepsy is minimal, if any. Discontinuation of drug treatment does not seem to affect the long-term prognosis but exposes patients who were seizure-free for years to a transient two-fold risk of seizures for the first 2 years after stopping AEDs. In addition, 20% of patients who were seizure-free for years, do not become seizure-free immediately after restarting AED treatment after relapse. The list of potential pitfalls is long. Patients with juvenile myoclonic epilepsy, those with prior withdrawal attempts and late remission have a higher risk of relapse. Stopping AEDs in remission does not affect the long-term patterns of epilepsy and some patients report a better general health in a life without AEDs. High-risk patients should not be generally encouraged to stop their AEDs in remission. We need new drugs that combine anti-seizure and antiepileptogenic effects to prevent seizure relapse and flare up of epilepsy after stopping AEDs in remission. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  7. A nonsense mutation in the ERG6 gene leads to reduced susceptibility to polyenes in a clinical isolate of Candida glabrata.

    Science.gov (United States)

    Vandeputte, Patrick; Tronchin, Guy; Larcher, Gérald; Ernoult, Emilie; Bergès, Thierry; Chabasse, Dominique; Bouchara, Jean-Philippe

    2008-10-01

    Unlike the molecular mechanisms that lead to azole drug resistance, the molecular mechanisms that lead to polyene resistance are poorly documented, especially in pathogenic yeasts. We investigated the molecular mechanisms responsible for the reduced susceptibility to polyenes of a clinical isolate of Candida glabrata. Sterol content was analyzed by gas-phase chromatography, and we determined the sequences and levels of expression of several genes involved in ergosterol biosynthesis. We also investigated the effects of the mutation harbored by this isolate on the morphology and ultrastructure of the cell, cell viability, and vitality and susceptibility to cell wall-perturbing agents. The isolate had a lower ergosterol content in its membranes than the wild type, and the lower ergosterol content was found to be associated with a nonsense mutation in the ERG6 gene and induction of the ergosterol biosynthesis pathway. Modifications of the cell wall were also seen, accompanied by increased susceptibility to cell wall-perturbing agents. Finally, this mutation, which resulted in a marked fitness cost, was associated with a higher rate of cell mortality. Wild-type properties were restored by complementation of the isolate with a centromeric plasmid containing a wild-type copy of the ERG6 gene. In conclusion, we have identified the molecular event responsible for decreased susceptibility to polyenes in a clinical isolate of C. glabrata. The nonsense mutation detected in the ERG6 gene of this isolate led to a decrease in ergosterol content. This isolate may constitute a useful tool for analysis of the relevance of protein trafficking in the phenomena of azole resistance and pseudohyphal growth.

  8. Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa.

    Science.gov (United States)

    Cogley, Catherine B; Keel, Pamela K

    2003-09-01

    The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse. Copyright 2003 by Wiley Periodicals, Inc.

  9. Lead Poisoning

    Science.gov (United States)

    ... lead is of microscopic size, invisible to the naked eye. More often than not, children with elevated ... majority of the childhood lead poisoning cases we see today. Children and adults too can get seriously ...

  10. Relational Leading

    DEFF Research Database (Denmark)

    2015-01-01

    This first chapter presents the exploratory and curious approach to leading as relational processes – an approach that pervades the entire book. We explore leading from a perspective that emphasises the unpredictable challenges and triviality of everyday life, which we consider an interesting......, relevant and realistic way to examine leading. The chapter brings up a number of concepts and contexts as formulated by researchers within the field, and in this way seeks to construct a first understanding of relational leading....

  11. Clinical analysis of 129 children with lead poisoning%儿童铅中毒129例门诊病例分析

    Institute of Scientific and Technical Information of China (English)

    郜振彦; 徐健; 古桂雄; 颜崇淮

    2014-01-01

    Objective To assess the distribution of blood lead levels and the sources of lead exposure in children with lead poisoning,and thus to offer recommendations for clinical diagnosis and treatment of childhood lead poisoning.Methods The clinical data of 129 patients with lead poisoning was collected and analyzed at the Out-patient Department of Lead Poisoning Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine during Sep.2012 and Aug.2013 were collected and analyzed.All children were required to fill out the " outpatient questionnaire on heavy metal" (including children's demographic data,growth assessment,frequency of hand-mouth behavior,and the behavior of washing hands before eating,dietary,sources of lead exposure,and the family environment,etc.).Other data of medical history,physical examinations (height,weight,growth and development) were also collected.Blood samples were collected to measure blood lead level by graphite furnace atomic absorption spectrometry.Results (1) The above 129 patients were from 14 provinces (municipalities and autonomous regions),including 64 cases in Zhejiang (49.6%),30 cases in Shanghai (23.0%),13 cases in Jiangsu (10.1%),6 cases in Jiangxi (4.7%),5 cases in Hebei (3.9%),2 cases in Anhui and Guangdong (1.6%) ;and 1 case in Fujian,Henan,Hunan,Jilin,Inner Mongolia,Heilongjiang and Shandong (0.8%),respectively.(2) In the patients,the blood lead level was 17.0-892.0 μg/L[(251.5 ±155.8) μg/L] and the median was 235.0 μg/L.(3)The mean age of the children was 4.3 years.Fifteen cases were less than 1 year old,and the mean blood lead level was (367.8 ± 137.7) μg/L.Thirty-seven cases were 1-3 years old children,and the mean blood lead level was (250.5 ± 116.3) μg/L.Fifty cases were 3-6 years old children,and the mean blood lead level was (237.7 ± 179.7) μg/L.Twenty-seven cases were over 6 years old,and the mean blood lead level was (213.9 ± 141.8) μg/L.(4) One hundred and eleven cases of the

  12. 不同剂量复方甲亢片对甲亢缓解期亚临床甲状腺功能亢进疗效影响的临床观察%Clinical Effects of Different Dosages of Compound Antithyroid Tablet on Subclinical Hyperthyroidism in Remission

    Institute of Scientific and Technical Information of China (English)

    王前

    2016-01-01

    Objective To explore the clinical effects of different dosages of compound antithyroid tablet on subclinical hyperthyroidism. Methods Chose 120 cases of patients with subclinical hyperthyroidism,divided them into three groups by therapeutic dosages,the low-dosage group,the middle-dosage group and the high-dosage group of which each had 40 cases,and observed the therapeutic effects of three groups. Results The therapeutic results of high-dosage and middle-dosage groups were better than that of low-dosage group(P < 0.05). After the treatment,three groups’TSH level rises greatly(P < 0.05),but FT3 and FT4 are still in the normal range. Conclusion The compound antithyroid tablet has significant clinical effects on subclinical hyperthyroidism and the proper increase in dosage can improve therapeutic effects,thus is suitable for clinical application.%目的:探讨不同剂量复方甲亢片对亚临床甲状腺功能亢进疗效的影响。方法选取120例亚临床甲亢患者,按照各自所用治疗药物剂量的不同分成3组,分别为低剂量组、中剂量组与高剂量组,每组患者均为40例,观察各组患者治疗效果。结果高剂量组与中剂量组治疗效果优于低剂量组(P <0.05),治疗后,各组 TSH 水平上升(P <0.05);但 FT3、FT4水平仍处于正常范围内。结论复方甲亢片治疗亚临床甲亢临床效果显著,并且适当增加用药剂量可以提高治疗效果,临床使用时可加以利用。

  13. ABCB1 polymorphism predicts escitalopram dose needed for remission in major depression

    Science.gov (United States)

    Singh, A B; Bousman, C A; Ng, C H; Byron, K; Berk, M

    2012-01-01

    The ATP-binding cassette family of transporter proteins, subfamily B (MDR/TAP), member 1 (ABCB1) (P-glycoprotein) transporter is a key component of the blood–brain barrier. Many antidepressants are subject to ABCB1 efflux. Functional polymorphisms of ABCB1 may influence central nervous system bioavailability of antidepressants subject to efflux. Single-nucleotide polymorphisms (SNPs) at rs1045642 (C3435T) of ABCB1 have been associated with efflux pump efficiency. This may explain part of the interindividual variation in antidepressant dose needed to remit. Individuals (N=113) with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) major depressive disorder (MDD) were treated with escitalopram (ESC) or venlafaxine (VEN) over 8 weeks. The17-item Hamilton Depression Rating Scale was assessed serially, blind to genotype. SNP rs1045642 of ABCB1 along with two SNPs previously reported to be in linkage disequilibrium with it (rs2032582 and rs1128503) were genotyped. Demographic features, clinical features, P450 metabolizer status and 5-HTTLPR (serotonin-transporter-linked promoter region) genotype were controlled for. Carriers of rs1045642 TT needed on average 11 mg of ESC to remit, whereas TC and CC carriers required 24 and 19 mg, respectively (P=0.0001). This equates to a 2.0- (95% confidence interval=1.5–3.4; P<0.001) fold greater ESC dose needed to remit for C carriers compared with TT carriers at rs1045642. Of VEN-treated subjects carrying TT genotype at rs1045642, 73.3% remitted compared with 12.5% for CC genotype (odds ratio=6.69; 95% confidence interval=1.72–25.9, P=0.006). These data suggest that antidepressant dose needed to remit can be predicted by an ABCB1 SNP. This has the potential clinical translation implications for dose selection and remission from MDD. PMID:23188198

  14. Long-term remission in mantle cell lymphoma following high-dose sequential chemotherapy and in vivo rituximab-purged stem cell autografting (R-HDS regimen).

    Science.gov (United States)

    Gianni, Alessandro M; Magni, Michele; Martelli, Maurizio; Di Nicola, Massimo; Carlo-Stella, Carmelo; Pilotti, Silvana; Rambaldi, Alessandro; Cortelazzo, Sergio; Patti, Caterina; Parvis, Guido; Benedetti, Fabio; Capria, Saveria; Corradini, Paolo; Tarella, Corrado; Barbui, Tiziano

    2003-07-15

    Mantle cell lymphoma (MCL) is rarely cured with standard-dose chemotherapy. From January 1997 to February 2000, 28 previously untreated advanced-stage MCL patients younger than 61 years of age were treated at 9 Italian hematologic departments with 3 cycles of standard-dose debulking chemotherapy followed by a high-dose rituximab-supplemented sequence (R-HDS) including intravenous administration of high-dose cyclophosphamide, high-dose cytarabine, high-dose melphalan, and high-dose mitoxantrone plus melphalan. Study end points included toxicity, clinical and molecular response rates, long-term event-free survival (EFS), and overall survival (OS) rates, as well as the ability to harvest tumor-free peripheral blood stem cells. Optimal amounts of polymerase chain reaction-negative (PCR-negative) CD34+ cells were collected from all 20 informative patients. One patient died of toxicity. All 27 patients assessable for response achieved a complete response (CR), of which 24 remain in continuous complete remission (CCR) after a median follow-up of 35 months. Three patients had transient evidence of PCR-detectable disease in the bone marrow. The OS and EFS rates at 54 months were 89% and 79%, respectively. These results compare with the 42% OS rate and the 18% EFS rate observed in 35 age-matched historic controls treated with standard-dose chemotherapy at the participating centers. The use of rituximab in combination with high-dose chemotherapy represents a very effective in vivo purging method. The R-HDS regimen can be safely applied in a multicenter hematology setting and leads to long-term EFS and OS in the majority of patients with an otherwise incurable disease.

  15. Deferasirox treatment improved hematopoiesis and led to complete remission in a patient with pure red cell aplasia.

    Science.gov (United States)

    Kojima, Minoru; Machida, Shinichiro; Sato, Ai; Miyamoto, Mitsuki; Moriuchi, Makiko; Ohbayashi, Yoshiaki; Ando, Kiyoshi

    2013-12-01

    A 64-year-old woman developed pure red cell aplasia (PRCA) 4 years after thymectomy for thymoma. During anti-thymocyte globulin treatment, the patient developed cytomegalovirus pneumonia and was thus unable to continue immunosuppressive therapy and became transfusion dependent. Deferasirox was started for treatment with iron overload when serum ferritin increased to >1000 ng/mL. Seven months after initiation of deferasirox treatment, serum ferritin level decreased the normal range and the patient has remained transfusion independent thereafter. Deferasirox was discontinued when serum ferritin level decreased below 500 ng/mL, and she has maintained in complete remission over the last 15 months. Hypotheses have been raised regarding the improvement of hematopoiesis by deferasirox treatment, but the mechanism whereby this might be achieved remains unclear. Deferasirox treatment may be clinically beneficial both by reducing iron overload and by improving hematopoiesis in patients with PRCA.

  16. [Spontaneous remission of HCV infection after autologous stem cell transplantation in a 58-year-old man].

    Science.gov (United States)

    Reinhardt, L; Eiffert, H; Wulf, G; Ströbel, P; Bremer, S C B; Amanzada, A; Ellenrieder, V; Neesse, A

    2017-02-24

    We report about a 58-year-old man with a chronic and treatment-naive hepatitis C virus (HCV) infection of genotype 1b, who had undergone autologous stem cell transplantation twice due to multiple myeloma. Subsequently, a high-level viremic reactivation of an occult hepatitis B virus (HBV) infection and also a reverse seroconversion was observed. Furthermore, a sustained spontaneous remission of HCV infection was seen. Antiviral therapy of HBV infection was initiated with tenofovir. Seven months after therapy initiation, the patient acquired an "anti-HBc-only" status. Antiviral therapy with tenofovir is still continued. The patient is in a good clinical condition.

  17. Human immunodeficiency virus-associated giant conjunctival Kaposi's sarcoma: complete remission with antiretroviral therapy and systemic chemotherapy.

    Science.gov (United States)

    Eduardo-Sánchez, Y W; Fernández-Agrafojo, D

    2017-09-05

    A 35-year-old male patient with a large unilateral haemorrhagic conjunctival tumour lesion and another contralateral haemorrhagic conjunctival flat lesion associated with violaceous cutaneous macules on the extremities and angiomatous lesions in the upper gastrointestinal tract as initial clinical manifestation of HIV-related immunodeficiency. Cutaneous, gastric mucosal and conjunctival biopsy was consistent with Kaposi's sarcoma with complete remission after highly active antiretroviral therapy and systemic chemotherapy. HIV-related conjunctival Kaposi's sarcoma, even a large one, can have a good response to antiretroviral therapy and systemic chemotherapy without any additional topical eye treatment. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Association of IL-1ra and adiponectin with C-peptide and remission in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Pfleger, C.; Hansen, L.; Herder, C.

    2008-01-01

    OBJECTIVE: We investigated the association of anti-inflammatory cytokine interleukin (IL)-1 receptor antagonist (IL-1ra), adiponectin, proinflammatory cytokines IL-1 beta, IL-6, and CCL2, and tumor necrosis factor-alpha with beta-cell function, metabolic status, and clinical remission in patients...... with recent-onset type 1 diabetes. RESEARCH DESIGN AND METHODS: Serum was obtained from 256 newly diagnosed patients (122 males and 134 females, median age 9.6 years). Stimulated C-peptide, blood glucose, and A1C were determined in addition to circulating concentration of cytokines at 1, 6, and 12 months...... after diagnosis. Analyses were adjusted for sex, age, and BMI percentile. RESULTS: Anti-inflammatory IL-1ra was positively associated with C-peptide after 6 (P = 0.0009) and 12 (P = 0.009) months. The beneficial association of IL-1ra on beta-cell function was complemented by the negative association...

  19. Predictors of European League Against Rheumatism (EULAR) good response, DAS-28 remission and sustained responses to TNF-inhibitors in rheumatoid arthritis: a prospective study in refractory disease.

    Science.gov (United States)

    Mohammed, Reem Hamdy A; Farahat, Faisal; Kewan, Hanady H; Bukhari, Mohammed A

    2015-01-01

    The aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years' study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + -17.9 years, mean disease duration 7.3 + -5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P EULAR good response and were significant predictors of sustained response to TNF-I.

  20. Spontaneous Remission of an Untreated, MYC and BCL2 Coexpressing, High-Grade B-Cell Lymphoma: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    D. Alan Potts

    2017-01-01

    Full Text Available Non-Hodgkin lymphomas (NHL are a heterogeneous group of hematologic malignancies typically treated with multiagent chemotherapy. Rarely, spontaneous remissions can be observed, particularly in more indolent subtypes. The prognosis of aggressive NHL can be predicted using clinical and histopathologic factors. In aggressive B-cell NHL, the importance of MYC and BCL2 proto-oncogene coexpression (as assessed by immunohistochemistry and high-grade histologic features are particularly noteworthy. We report a unique case of spontaneous remission in a patient with an aggressive B-cell NHL which harbored high-risk histopathologic features, including MYC protein expression at 70–80%, BCL2 protein expression, and morphologic features suggestive of high-grade B-cell lymphoma, NOS (formerly B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma [BCLU]. After undergoing a biopsy to confirm this diagnosis, he opted to forego curative-intent chemotherapy. The single, yet relatively large area of involvement noted on 18F-fluorodeoxyglucose positron emission tomography-computed tomography steadily resolved on subsequent follow-up studies. He remained without evidence of recurrence one year later, having never received treatment. This case emphasizes the potential for spontaneous remission in NHL and demonstrates that this phenomenon can be observed despite contemporary high-risk histopathologic features.

  1. Mental Fatigue and Executive Dysfunction in Patients with Cushing's Syndrome in Remission.

    Science.gov (United States)

    Papakokkinou, Eleni; Johansson, Birgitta; Berglund, Peter; Ragnarsson, Oskar

    2015-01-01

    Patients with Cushing's syndrome (CS) in remission often suffer from impaired quality of life and cognitive dysfunction. The primary aim was to investigate the occurrence of mental fatigue, characterized by mental exhaustion and long recovery time following mentally strenuous tasks, in patients with CS in remission. The secondary aim was to examine whether the newly developed parts C and D of the trail making test (TMT) are more sensitive, compared to the conventional parts A and B, to evaluate attention and executive function. This was a cross-sectional study including 51 patients with CS in remission and 51 controls. All subjects completed the self-administrated mental fatigue scale (MFS) and performed all four parts of the TMT. The patients had worse outcome on all components of the MFS except for sensitivity to noise. After adjustment for mental fatigue, depression, and anxiety, the patients performed worse only on part D of the TMT (P Mental fatigue is common in patients with CS in remission and can be captured by using the MFS. The most demanding part of the TMT, part D, is more useful to capture cognitive deficits in patients with CS in remission compared to the conventional parts A and B.

  2. Gluten-free diet does not appear to induce endoscopic remission of eosinophilic esophagitis in children with coexistent celiac disease

    Science.gov (United States)

    Abraham, Joseph R; Persad, Rabin; Turner, Justine M; Huynh, Hien Q

    2012-01-01

    BACKGROUND: Celiac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. It is unknown whether eosinophilic esophagitis in patients with celiac disease responds to a gluten-free diet. OBJEVTIVES: To examine the clinical, endoscopic and histological features of children with both conditions to evaluate whether eosinophilic esophagitis responds to a gluten-free diet. METHODS: From January 1, 2009, to June 30, 2011, the medical records of children <18 years of age diagnosed with eosinophilic esophagitis and/or celiac disease were reviewed. Patients with clinical, endoscopic and histological diagnoses of both diseases were identified and included. These findings were analyzed, as were laboratory results, treatment and follow-up. RESULTS: During the study period, there were 206 celiac disease patients, 86 eosinophilic esophagitis patients and nine (4.4% of total celiac) patients with both diagnoses. Gluten-free diet was the primary treatment for both conditions in seven of nine (78%) cases. In six of these seven (86%) patients, no endoscopic or histological improvement of eosinophilic esophagitis was observed, while in one patient, histological remission of esophageal eosinophilia occurred while on a gluten-free diet. CONCLUSION: The prevalence of eosinophilic esophagitis in patients with celiac disease was 4.4%, confirming a higher than expected prevalence of eosinophilic esophagitis compared with the general population. In patients with celiac disease, a gluten-free diet did not appear to induce remission of coexistent endoscopic and histological features of eosinophilic esophagitis. PMID:22891176

  3. Infliximab biosimilar CT-P13 therapy is effective and safe in maintaining remission in Crohn's disease and ulcerative colitis - experiences from a single center.

    Science.gov (United States)

    Farkas, Klaudia; Rutka, Mariann; Ferenci, Tamás; Nagy, Ferenc; Bálint, Anita; Bor, Renáta; Milassin, Ágnes; Fábián, Anna; Szántó, Kata; Végh, Zsuzsanna; Kürti, Zsuzsanna; Lakatos, Péter L; Szepes, Zoltán; Molnár, Tamás

    2017-08-18

    CT-P13, the first biosimilar monoclonal antibody to infliximab (IFX), has been confirmed to be efficacious in inducing remission in inflammatory bowel diseases (IBD). The aim of this study was to evaluate the long-term efficacy and safety of CT-P13 therapy in Crohn's disease (CD) and ulcerative colitis (UC), and to identify predictors of sustained clinical response during a 54-week CT-P13 treatment period. Patients with CD and UC, who were administered CT-P13, were prospectively enrolled. Clinical response was assessed at week 14 and week 54. Predictive factors for disease outcome at week 54 were evaluated. 57 CD and 57 UC patients were included; 55 CD and 49 UC patients completed the induction therapy and 50 CD and 46 UC patients completed the 54-week treatment period. Clinical remission was achieved in 65.5% of CD and 75.5% of UC patients at week 14. Rate of continuous clinical response was 51% in both CD and UC at week 54. None of the examined parameters were predictive to the clinical outcome neither in CD, nor in UC. This study confirmed the long-term efficacy and safety of CT-P13 therapy in IBD. Response rates at week 54 were similar in CD and UC.

  4. Structure-Guided Lead Optimization of Triazolopyrimidine-Ring Substituents Identifies Potent Plasmodium falciparum Dihydroorotate Dehydrogenase Inhibitors with Clinical Candidate Potential

    Energy Technology Data Exchange (ETDEWEB)

    Coteron, Jose M.; Marco, Maria; Esquivias, Jorge; Deng, Xiaoyi; White, Karen L.; White, John; Koltun, Maria; El Mazouni, Farah; Kokkonda, Sreekanth; Katneni, Kasiram; Bhamidipati, Ravi; Shackleford, David M.; Angulo-Barturen, Inigo; Ferrer, Santiago B.; Jimenez-Diaz, Maria Belen; Gamo, Francisco-Javier; Goldsmith, Elizabeth J.; Charman, William N.; Bathurst, Ian; Floyd, David; Matthews, David; Burrows, Jeremy N.; Rathod, Pradipsinh K.; Charman, Susan A.; Phillips, Margaret A. (UWASH); (MMV, Switzerland); (GSK); (Monash); (UW); (UTSMC)

    2012-02-27

    Drug therapy is the mainstay of antimalarial therapy, yet current drugs are threatened by the development of resistance. In an effort to identify new potential antimalarials, we have undertaken a lead optimization program around our previously identified triazolopyrimidine-based series of Plasmodium falciparum dihydroorotate dehydrogenase (PfDHODH) inhibitors. The X-ray structure of PfDHODH was used to inform the medicinal chemistry program allowing the identification of a potent and selective inhibitor (DSM265) that acts through DHODH inhibition to kill both sensitive and drug resistant strains of the parasite. This compound has similar potency to chloroquine in the humanized SCID mouse P. falciparum model, can be synthesized by a simple route, and rodent pharmacokinetic studies demonstrated it has excellent oral bioavailability, a long half-life and low clearance. These studies have identified the first candidate in the triazolopyrimidine series to meet previously established progression criteria for efficacy and ADME properties, justifying further development of this compound toward clinical candidate status.

  5. Lead Test

    Science.gov (United States)

    ... months, and at 3, 4, 5, and 6 years of age. A blood lead level test should be done only if the risk ... recommended if the person is symptomatic at any level below 70 mcg/dL. Because lead will pass through the blood to an unborn child, pregnant ...

  6. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes – a retrospective cohort study

    OpenAIRE

    Ugale, Surendra; Gupta, Neeraj; Modi, Kirtikumar D; Kota, Sunil K.; Satwalekar, Vasisht; Naik, Vishwas; Swapna, Modukuri; Kumar, KVS Hari

    2014-01-01

    Background Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG). Methods In this retrospective study, we analyzed records ...

  7. Sustained remission in lupus nephritis: still a hard road ahead.

    Science.gov (United States)

    Quintana, Luis F; Jayne, David

    2016-12-01

    End-stage renal disease caused by lupus nephritis (LN) is an avoidable outcome yet there is considerable uncertainty and variability among nephrologists in their approaches to this disorder. This review discusses recent evidence relevant to the management of LN including recent consensus statements. Long-term results are encouraging compared with 30 years ago, but despite the use of the best available current therapies and achieving high levels of early clinical responses, the kidney often sustains long-term damage and nephritis relapses affect over 50%. Major hurdles to management include the complexity of the clinical presentation, histological features and serological tests, and the absence of reliable outcome predictors or markers of treatment response. The key serological and histopathological characteristics relevant to the practising nephrologist are reviewed, and the limitations of current disease activity markers discussed. There are many potential biomarkers under evaluation, and a framework for their validation is presented. Clinical trials of existing or newer agents for LN have typically been inconclusive and have raised problems of trial design and interpretation that are a barrier to new drug development. The major issues affecting clinical trial design and their potential solutions are summarized.

  8. Farnesyl transferase inhibitors induce extended remissions in transgenic mice with mature B cell lymphomas

    Directory of Open Access Journals (Sweden)

    Refaeli Yosef

    2008-05-01

    Full Text Available Abstract Background We have used a mouse model based on overexpression of c-Myc in B cells genetically engineered to be self-reactive to test the hypothesis that farnesyl transferase inhibitors (FTIs can effectively treat mature B cell lymphomas. FTIs are undergoing clinical trials to treat both lymphoid and non-lymphoid malignancies and we wished to obtain evidence to support the inclusion of B cell lymphomas in future trials. Results We report that two FTIs, L-744,832 and SCH66336, blocked the growth of mature B cell lymphoma cells in vitro and in vivo. The FTI treatment affected the proliferation and survival of the transformed B cells to a greater extent than naïve B cells stimulated with antigen. In syngeneic mice transplanted with the transgenic lymphoma cells, L-744,832 treatment prevented the growth of the tumor cells and the morbidity associated with the resulting lymphoma progression. Tumors that arose from transplantation of the lymphoma cells regressed with as little as three days of treatment with L-744,832 or SCH66336. Treatment of these established lymphomas with L-744,832 for seven days led to long-term remission of the disease in approximately 25% of animals. Conclusion FTI treatment can block the proliferation and survival of self-reactive transformed B cells that overexpress Myc. In mice transplanted with mature B cell lymphomas, we found that FTI treatment led to regression of disease. FTIs warrant further consideration as therapeutic agents for mature B cell lymphomas and other lymphoid tumors.

  9. A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Young Min Cho

    2014-12-01

    Full Text Available A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

  10. Rates and predictors of remission in young women with specific phobia: a prospective community study.

    Science.gov (United States)

    Trumpf, Julia; Becker, Eni S; Vriends, Noortje; Meyer, Andrea H; Margraf, Jürgen

    2009-10-01

    This prospective study reports rates and predictors of remission in young women with specific phobia. Data came from a prospective community study, in which German women (aged 18-25 years) completed an extended version of the Anxiety Disorders Interview Schedule (ADIS-IV-L) at two time points. Of the 137 women with specific phobia at baseline, 41.6% were partially remitted and an additional 19.0% were fully remitted at follow-up, defined as absence of any specific fears. A remitting course of specific phobia was predicted by residual protective factors at baseline, especially participants' positive mental health and life satisfaction. Baseline levels of stress, coping skills, cognitive factors, psychopathology, and specific phobia characteristics did not predict remission. Results show that specific phobia in young women rarely takes a stable course at the full diagnostic threshold. The factors that influence remission of specific phobia are different from those that predict the incidence.

  11. Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

    Institute of Scientific and Technical Information of China (English)

    Carlos Teruel; Elena Garrido; Francisco Mesonero

    2016-01-01

    Inflammatory bowel disease(IBD) patients in remission may suffer from gastrointestinal symptoms that resemble irritable bowel syndrome(IBS). Knowledge on this issue has increased considerably in the last decade, and it is our intention to review and summarize it in the present work. We describe a problematic that comprises physiopathological uncertainties, diagnostic difficulties, as IBS-like symptoms are very similar to those produced by an inflammatory flare, and the necessity of appropriate management of these patients, who, although in remission, have impaired quality of life. Ultimately, from almost a philosophical point of view, the presence of IBS-like symptoms in IBD patients in remission supposes a challenge to the traditional functional-organic dichotomy, suggesting the need for a change of paradigm.

  12. In-vivo remission spectroscopy on tattoos and topically applied photosensitizers in man

    Science.gov (United States)

    Koenig, Karsten; Beck, Gerd C.; Boehncke, Wolf-Henning; Kaufmann, Roland; Hibst, Raimund

    1994-02-01

    In-vivo remission spectra of the human skin in the spectral region of 400 nm to 800 nm were recorded using a xenon lamp as an excitation source, a fiberoptical sensor combined with a polychromator, and a multichannel analyzer. The remission of amateur tattoos before and after laser treatment (Q-switched Nd:YAG) was measured and the degree of blanching determined. It was found that the process of blanching proceeds partly reversible. In another study, the time-dependent remission of human skin after topical administration of the photosensitizer Methylene Blue was studied. The additional application of the ceratolytic agent urea promotes the penetration of the thiazine dye. The experimental data were analyzed by the Kubelka Munk theory.

  13. Maintaining remission in ulcerative colitis – role of once daily extended-release mesalamine

    Directory of Open Access Journals (Sweden)

    Lilliana Oliveira

    2011-02-01

    Full Text Available Lilliana Oliveira, Russell D CohenThe Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center, Chicago, IL, USAAbstract: The aminosalicylates (5-ASA; also referred to as mesalamine-based agents are considered as first-line in the maintenance of remission of mild to moderate ulcerative colitis (UC. Traditionally these agents have required a large pill burden and multiple daily dosing regimens which may account for the low adherence rates, especially in patients in remission. Extended-release mesalamine is the first once daily mesalamine product approved by the Food and Drug Administration for the maintenance of UC remission. This review will examine the pharmacokinetics, dosing, efficacy, and safety data of extended-release mesalamine, and discuss the potential role of improving medication compliance and decreasing costs in UC maintenance.Keywords: ulcerative colitis, 5-ASA, mesalamine, adherence, compliance, quality of life, costs

  14. Time courses of improvement and symptom remission in children treated with atomoxetine for attention-deficit/hyperactivity disorder: analysis of Canadian open-label studies

    Directory of Open Access Journals (Sweden)

    Turgay Atilla

    2011-05-01

    Full Text Available Abstract Background The relatively short durations of the initial pivotal randomized placebo-controlled trials involving atomoxetine HCl for the treatment of attention-deficit/hyperactivity disorder (ADHD provided limited insight into the time courses of ADHD core symptom responses to this nonstimulant, selective norepinephrine reuptake inhibitor. The aim of this analysis was to evaluate time courses of treatment responses or remission, as assessed by attainment of prespecified scores on the ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored (ADHDRS-IV-PI and the Clinical Global Impressions-ADHD-Severity (CGI-ADHD-S scales, during up to 1 year of atomoxetine treatment in children with ADHD. Methods Using pooled data from three Canadian open-label studies involving 338 children ages 6-11 years with ADHD who were treated with atomoxetine for 3, 6 and 12 months, and survival analysis methods for interval-censored data, we estimated the time to: 1 improvement and robust improvement defined by ≥25% and ≥40% reductions from baseline ADHDRS-IV-PI total scores, respectively; and 2 remission using two definitions: a final score of ADHDRS-IV-PI ≤18 or a final score of CGI-ADHD-S ≤2. Results The median time to improvement was 3.7 weeks (~1 month, but remission of symptoms did not occur until a median of 14.3 weeks (~3.5 months using the most stringent CGI-ADHD-S threshold. Probabilities of robust improvement were 47% at or before 4 weeks of treatment; 76% at 12 weeks; 85% at 26 weeks; and 96% at 52 weeks. Probabilities of remission at these corresponding time points were 30%, 59%, 77%, and 85% (using the ADHDRS-IV scale and 8%, 47%, 67%, and 75% (using the CGI-ADHD-S scale. The change from atomoxetine treatment month 5 to month 12 of -1.01 (1.03 was not statistically significant (p = .33. Conclusions Reductions in core ADHD symptoms during atomoxetine treatment are gradual. Although approximately one-half of study

  15. Sustained Remission Improves Physical Function in Patients with Established Rheumatoid Arthritis, and Should Be a Treatment Goal

    DEFF Research Database (Denmark)

    Einarsson, Jon Thorkell; Geborek, Pierre; Saxne, Tore

    2016-01-01

    OBJECTIVE: It has been proposed that remission should be maintained throughout the course of rheumatoid arthritis (RA); however, the evidence supporting this is limited. Physical function measured by the Health Assessment Questionnaire (HAQ) is a major outcome in RA, and HAQ is shown to be one...... treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) ... measured by the HAQ improves in patients reaching SR compared with patients who only occasionally reach remission. The improvement continues while in remission, which supports that maintaining remission should be a treatment goal....

  16. HIV Reactivation from Latency after Treatment Interruption Occurs on Average Every 5-8 Days--Implications for HIV Remission.

    Directory of Open Access Journals (Sweden)

    Mykola Pinkevych

    2015-07-01

    Full Text Available HIV infection can be effectively controlled by anti-retroviral therapy (ART in most patients. However therapy must be continued for life, because interruption of ART leads to rapid recrudescence of infection from long-lived latently infected cells. A number of approaches are currently being developed to 'purge' the reservoir of latently infected cells in order to either eliminate infection completely, or significantly delay the time to viral recrudescence after therapy interruption. A fundamental question in HIV research is how frequently the virus reactivates from latency, and thus how much the reservoir might need to be reduced to produce a prolonged antiretroviral-free HIV remission. Here we provide the first direct estimates of the frequency of viral recrudescence after ART interruption, combining data from four independent cohorts of patients undergoing treatment interruption, comprising 100 patients in total. We estimate that viral replication is initiated on average once every ≈6 days (range 5.1- 7.6 days. This rate is around 24 times lower than previous thought, and is very similar across the cohorts. In addition, we analyse data on the ratios of different 'reactivation founder' viruses in a separate cohort of patients undergoing ART-interruption, and estimate the frequency of successful reactivation to be once every 3.6 days. This suggests that a reduction in the reservoir size of around 50-70-fold would be required to increase the average time-to-recrudescence to about one year, and thus achieve at least a short period of anti-retroviral free HIV remission. Our analyses suggests that time-to-recrudescence studies will need to be large in order to detect modest changes in the reservoir, and that macaque models of SIV latency may have much higher frequencies of viral recrudescence after ART interruption than seen in human HIV infection. Understanding the mean frequency of recrudescence from latency is an important first step in

  17. A computer-human interaction model to improve the diagnostic accuracy and clinical decision-making during 12-lead electrocardiogram interpretation.

    Science.gov (United States)

    Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Breen, Cathal; Guldenring, Daniel; Gaffney, Robert; Gallagher, Anthony G; Peace, Aaron J; Henn, Pat

    2016-12-01

    The 12-lead Electrocardiogram (ECG) presents a plethora of information and demands extensive knowledge and a high cognitive workload to interpret. Whilst the ECG is an important clinical tool, it is frequently incorrectly interpreted. Even expert clinicians are known to impulsively provide a diagnosis based on their first impression and often miss co-abnormalities. Given it is widely reported that there is a lack of competency in ECG interpretation, it is imperative to optimise the interpretation process. Predominantly the ECG interpretation process remains a paper based approach and whilst computer algorithms are used to assist interpreters by providing printed computerised diagnoses, there are a lack of interactive human-computer interfaces to guide and assist the interpreter. An interactive computing system was developed to guide the decision making process of a clinician when interpreting the ECG. The system decomposes the interpretation process into a series of interactive sub-tasks and encourages the clinician to systematically interpret the ECG. We have named this model 'Interactive Progressive based Interpretation' (IPI) as the user cannot 'progress' unless they complete each sub-task. Using this model, the ECG is segmented into five parts and presented over five user interfaces (1: Rhythm interpretation, 2: Interpretation of the P-wave morphology, 3: Limb lead interpretation, 4: QRS morphology interpretation with chest lead and rhythm strip presentation and 5: Final review of 12-lead ECG). The IPI model was implemented using emerging web technologies (i.e. HTML5, CSS3, AJAX, PHP and MySQL). It was hypothesised that this system would reduce the number of interpretation errors and increase diagnostic accuracy in ECG interpreters. To test this, we compared the diagnostic accuracy of clinicians when they used the standard approach (control cohort) with clinicians who interpreted the same ECGs using the IPI approach (IPI cohort). For the control cohort, the

  18. Spontaneous complete remission of type 1 diabetes mellitus in an adult – review and case report

    Directory of Open Access Journals (Sweden)

    Harsha Moole

    2015-10-01

    Full Text Available Type 1 diabetes mellitus (T1DM is an autoimmune condition that results in low plasma insulin levels by destruction of beta cells of the pancreas. As part of the natural progression of this disease, some patients regain beta cell activity transiently. This period is often referred to as the ‘honeymoon period’ or remission of T1DM. During this period, patients manifest improved glycemic control with reduced or no use of insulin or anti-diabetic medications. The incidence rates of remission and duration of remission is extremely variable. Various factors seem to influence the remission rates and duration. These include but are not limited to C-peptide level, serum bicarbonate level at the time of diagnosis, duration of T1DM symptoms, haemoglobin A1C (HbA1C levels at the time of diagnosis, sex, and age of the patient. Mechanism of remission is not clearly understood. Extensive research is ongoing in regard to the possible prevention and reversal of T1DM. However, most of the studies that showed positive results were small and uncontrolled. We present a 32-year-old newly diagnosed T1DM patient who presented with diabetic ketoacidosis (DKA and HbA1C of 12.7%. She was on basal bolus insulin regimen for the first 4 months after diagnosis. Later, she stopped taking insulin and other anti-diabetic medications due to compliance and logistical issues. Eleven months after diagnosis, her HbA1C spontaneously improved to 5.6%. Currently (14 months after T1DM diagnosis, she is still in complete remission, not requiring insulin therapy.

  19. Spontaneous complete remission of type 1 diabetes mellitus in an adult - review and case report.

    Science.gov (United States)

    Moole, Harsha; Moole, Vishnu; Mamidipalli, Adrija; Dharmapuri, Sowmya; Boddireddy, Raghuveer; Taneja, Deepak; Sfeir, Hady; Gajula, Sonia

    2015-01-01

    Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results in low plasma insulin levels by destruction of beta cells of the pancreas. As part of the natural progression of this disease, some patients regain beta cell activity transiently. This period is often referred to as the 'honeymoon period' or remission of T1DM. During this period, patients manifest improved glycemic control with reduced or no use of insulin or anti-diabetic medications. The incidence rates of remission and duration of remission is extremely variable. Various factors seem to influence the remission rates and duration. These include but are not limited to C-peptide level, serum bicarbonate level at the time of diagnosis, duration of T1DM symptoms, haemoglobin A1C (HbA1C) levels at the time of diagnosis, sex, and age of the patient. Mechanism of remission is not clearly understood. Extensive research is ongoing in regard to the possible prevention and reversal of T1DM. However, most of the studies that showed positive results were small and uncontrolled. We present a 32-year-old newly diagnosed T1DM patient who presented with diabetic ketoacidosis (DKA) and HbA1C of 12.7%. She was on basal bolus insulin regimen for the first 4 months after diagnosis. Later, she stopped taking insulin and other anti-diabetic medications due to compliance and logistical issues. Eleven months after diagnosis, her HbA1C spontaneously improved to 5.6%. Currently (14 months after T1DM diagnosis), she is still in complete remission, not requiring insulin therapy.

  20. Complete Remission of Minimal Change Disease Following an Improvement of Lung Mycobacterium avium Infection.

    Science.gov (United States)

    Yamashiro, Aoi; Uchida, Takahiro; Ito, Seigo; Oshima, Naoki; Oda, Takashi; Kumagai, Hiroo

    A 46-year-old woman suddenly developed peripheral edema. Her massive proteinuria, hypoproteinemia, and renal biopsy findings yielded the diagnosis of minimal change disease (MCD). In addition, lung Mycobacterium avium infection was diagnosed according to a positive culture of her bronchoalveolar lavage fluid. The lung lesion was improved by anti-nontuberculous mycobacteria therapy. Surprisingly, her proteinuria also gradually decreased and she attained complete remission of MCD without any immunosuppressive therapy. She has subsequently remained in complete remission. We herein report an interesting case of MCD with lung Mycobacterium avium infection, suggesting a causal relationship among infection, immune system abnormality, and MCD/nephrotic syndrome.

  1. THE POLICY OF GRANTING REMISSION TO CORRUPTION INMATES IN ORDER TO ERADICATE CORRUPTION IN INDONESIA

    Directory of Open Access Journals (Sweden)

    M Ali Zaidan

    2016-01-01

    Full Text Available Corruption is an extraordinary crime, even though the laws have been revised and has a more progressive character has also established Anti-Corruption Commission the number of crimes of corruption still do not show any significant change. In the midst of public pessimism, the Ministry of Justice and Human Rights has initiated efforts to revise the Government Regulation Number 99 Year 2012. The tightening of remission meant that the convict is not easy to get their sentences reduced. Attempts to revise the provisions concerning remission, it should consider how far can reduce corruption and its impact on inmates and the public

  2. Remission of nephrotic syndrome diminishes urinary plasmin content and abolishes activation of ENaC

    DEFF Research Database (Denmark)

    Andersen, René F; Buhl, Kristian Bergholt; Jensen, Boye L.;

    2013-01-01

    BACKGROUND: Urinary plasmin activates the epithelial Na(+) channel (ENaC) in vitro and may possibly be a mechanism of sodium retention in nephrotic syndrome (NS). This study used a paired design to test the hypothesis that remission of NS is associated with a decreased content of urinary plasmin...... and reduced ability of patients' urine to activate ENaC. METHODS: Samples were collected during active NS and at stable remission from 20 patients with idiopathic NS, aged 9.1 ± 3.2 years. Plasminogen-plasmin concentration was measured with an enzyme-linked immunosorbent assay. Western immunoblotting...

  3. Lorazepam-induced short-term remission of symptoms in a case of paranoid schizophrenia

    Directory of Open Access Journals (Sweden)

    Shubhangi R Parkar

    2011-01-01

    Full Text Available Conventionally, antipsychotics are used to treat schizophrenia due to predominant dopamine antagonist activity. The use of various types of Benzodiazepines (BZDs in the treatment of Schizophrenic symptoms like agitation and psychotic excitement in general and control of florid psychotic symptoms such as hallucinations and delusions in particular is well known. However, the use of BZDs, specifically in remission of paranoid schizophrenia, is not reported so far. Here, we are reporting a case of an elderly female patient with chronic paranoid schizophrenia showing short-term remission in paranoid symptoms with injectable lorazepam.

  4. Spontaneous complete remission of type 1 diabetes mellitus in an adult – review and case report

    OpenAIRE

    Moole, Harsha; Moole, Vishnu; Mamidipalli, Adrija; Dharmapuri, Sowmya; Boddireddy, Raghuveer; Taneja, Deepak; Sfeir, Hady; Gajula, Sonia

    2015-01-01

    Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results in low plasma insulin levels by destruction of beta cells of the pancreas. As part of the natural progression of this disease, some patients regain beta cell activity transiently. This period is often referred to as the ‘honeymoon period’ or remission of T1DM. During this period, patients manifest improved glycemic control with reduced or no use of insulin or anti-diabetic medications. The incidence rates of remission and...

  5. Comparative diagnostic performance of {sup 18}F-FDG PET/CT versus whole-body MRI for determination of remission status in multiple myeloma after stem cell transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Derlin, Thorsten; Peldschus, Kersten; Bannas, Peter; Herrmann, Jochen; Habermann, Christian R.; Adam, Gerhard; Weber, Christoph [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Muenster, Silvia [University Medical Center Hamburg-Eppendorf, Department of Nuclear Medicine, Hamburg (Germany); Stuebig, Thomas; Kroeger, Nicolaus [University Medical Center Hamburg-Eppendorf, Clinic for Stem Cell Transplantation, Hamburg (Germany)

    2013-02-15

    To compare the diagnostic performance of whole-body magnetic resonance imaging (WBMRI) versus {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography/computed tomography (PET/CT) for determination of remission status in patients with multiple myeloma (MM) after stem cell transplantation (SCT). Thirty-one patients were examined by both WBMRI and PET/CT after SCT. Imaging results and clinical remission status as determined by the clinical gold standard (Uniform Response Criteria) were compared. One hundred four lesions were detected in 21 patients. PET/CT had a sensitivity of 50.0 %, a specificity of 85.7 %, a positive predictive value of 62.5 %, a negative predictive value of 78.3 %, and an overall accuracy of 74.2 % for determination of remission status. MRI had a sensitivity of 80.0 %, a specificity of 38.1 %, a positive predictive value of 38.1 %, a negative predictive value of 80 %, and an overall accuracy of 51.6 %. Concordant results were observed in only 12 (11.5 %) of the 104 lesions. In the post-treatment setting, both FDG PET/CT and WBMRI provide information about the extent of disease, allowing for a more comprehensive evaluation of persisting or recurrent myeloma. MRI may often be false positive because of persistent non-viable lesions. Therefore, PET/CT might be more suitable than MRI for determination of remission status. (orig.)

  6. Lead Poisoning

    Science.gov (United States)

    ... Topics Environment & Health Healthy Living Pollution Reduce, Reuse, Recycle Science – How It Works The Natural World Games ... OTHERS: Lead has recently been found in some plastic mini-blinds and vertical blinds which were made ...

  7. Relation between the global burden of disease and randomized clinical trials conducted in Latin America published in the five leading medical journals.

    Directory of Open Access Journals (Sweden)

    Pablo Perel

    Full Text Available BACKGROUND: Since 1990 non communicable diseases and injuries account for the majority of death and disability-adjusted life years in Latin America. We analyzed the relationship between the global burden of disease and Randomized Clinical Trials (RCTs conducted in Latin America that were published in the five leading medical journals. METHODOLOGY/PRINCIPAL FINDINGS: We included all RCTS in humans, exclusively conducted in Latin American countries, and published in any of the following journals: Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine. We described the trials and reported the number of RCTs according to the main categories of the global burden of disease. Sixty-six RCTs were identified. Communicable diseases accounted for 38 (57% reports. Maternal, perinatal, and nutritional conditions accounted for 19 (29% trials. Non-communicable diseases represent 48% of the global burden of disease but only 14% of reported trials. No trial addressed injuries despite its 18% contribution to the burden of disease in 2000. CONCLUSIONS/SIGNIFICANCE: A poor correlation between the burden of disease and RCTs publications was found. Non communicable diseases and injuries account for up to two thirds of the burden of disease in Latin America but these topics are seldom addressed in published RCTs in the selected sample of journals. Funding bodies of health research and editors should be aware of the increasing burden of non communicable diseases and injuries occurring in Latin America to ensure that this growing epidemic is not neglected in the research agenda and not affected by publication bias.

  8. Spontaneous chronic subdural hematoma development in chronic myeloid leukemia cases at remission phase under maintenance therapy, management strategy - a series with literature review

    Directory of Open Access Journals (Sweden)

    Raheja Amol

    2016-09-01

    Full Text Available Chronic subdural hematoma (CSDH is common squeal of trauma and rarely associated with anticoagulant therapy, antiplatelet, chemotherapeutic drugs, arteriovenous malformation, aneurysms and post-craniotomy. However its occurrence is very unusual with systemic haematological malignancy and mostly reported with acute myeloid leukemia; however incidence of SDH occurrence in chronic myelogenous leukemia (CML is very rare. CML is a haematological malignancy characterized by chromosomal alteration, pathologically represents increased proliferation of the granulocytic cell line without loss of capacity to differentiate. CML has three phases - remission phase, accelerated phase and blast crisis. About 85 % of patients present in remission phase of disease and carries a favorable prognosis. As intracranial, subdural hematoma usually occur in the accelerated phase or blast crisis phase or extremely uncommon during chronic remission phase, although only those affected, who are neglecting therapeutic medication or discontinued therapy or rarely as an adverse effect of medications. However, important role of neurosurgeon lies in early detection and correction of platelet count and associated hematological abnormality as quite sizeable proportion of cases may not need surgical intervention instead can be managed conservatively under regular supervision in association with oncologist colleague, but few cases may need urgent surgical intervention. So, selecting a subgroup of CML cases in the remission phase requiring surgical intervention, presenting with CSDH is not only challenging, as failure to make an informed and timely precise decision can lead to catastrophic worse outcome and even mortality. So, purpose of current article is to formulate the management therapeutic plan. Authors report three cases of CML in chronic remission phase, receiving treatment under guidance of Haemto-oncologist at our institute presented with spontaneous chronic SDH. The mean

  9. Once daily oral mesalamine compared to conventional dosing for induction and maintenance of remission in ulcerative colitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Feagan, Brian G; MacDonald, John K

    2012-09-01

    We systematically reviewed and compared the efficacy and safety of once daily (OD) mesalamine to conventional dosing for induction and maintenance of remission in ulcerative colitis (UC). A literature search to January 2012 identified all applicable randomized trials. Study quality was evaluated using the Cochrane risk of bias tool. The GRADE criteria were used to assess the overall quality of the evidence. Studies were subgrouped by formulation for meta-analysis. Eleven studies that evaluated 4070 patients were identified. The risk of bias was low for most factors, although five studies were single-blind and one was open-label. No difference was observed between the dosing strategies in the proportion of patients with clinical remission (relative risk [RR] 0.95; 95% confidence interval [CI] 0.82-1.10), clinical improvement (RR 0.87 95% CI 0.68-1.10), or relapse at 6 (RR 1.10; 95% CI 0.83-1.46) or 12 months (RR 0.92; 95% CI 0.83-1.03). Subgroup analyses showed no important differences in efficacy. No significant difference was demonstrated in rates of medication adherence or adverse events between OD and conventional dosing. OD mesalamine appears to be as effective and safe as conventional dosing for both the treatment of mild to moderately active UC and for maintenance of remission in quiescent UC. The failure to demonstrate a superior rate of adherence to OD dosing may be due to the high rate of adherence observed in the clinical trials environment. Future research should assess the value of OD dosing in community settings.

  10. [Clinical remission of an HLA B27-positive sacroiliitis on vegan diet].

    Science.gov (United States)

    Huber, R; Herdrich, A; Rostock, M; Vogel, T

    2001-08-01

    Positive effects of fasting and vegan diet in patients with rheumatic diseases are reported in the literature. We present a 33-year-old patient with double-sided HLA B27-positive sacroiliitis, which was diagnosed by magnetic resonance tomography. Since about 10 years he therefore had pain in the iliosacral region. Numerous sessions of physiotherapy, a cure treatment, and treatment with sulfasalazine and doxycycline were not effective. The patient was dependent on the daily intake of the nonsteroidal antirheumatics meloxicam 2 x 7.5 mg and ibuprofen 400-800 mg and the analgetic tramadol 50-150 mg, but evening and night pain and morning stiffness persisted under this treatment. We recommended a temporary vegan diet, i.e. to completely avoid animal fats and proteins. 3-4 days after changing on vegan diet the complaints improved distinctly and persistently. After consumption of meat 6 weeks later, complaints worsened. Consequent vegan diet again resulted in significant improvement of the pain and morning stiffness. At follow-up 3 months after the initial contact, tramadol and ibuprofen intakes had been stopped, meloxicam had been reduced to 1 x 7.5 mg. The patient was almost completely free of complaints. It was demonstrated that in a single case of sacroiliitis which was refractory to other treatment, vegan diet resulted in a convincingly improvement of complaints. Copyright 2001 S. Karger GmbH, Freiburg

  11. Lead poisoning

    Science.gov (United States)

    ... ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 157. Woolf AD, Goldman R, Bellinger DC. Update on the clinical ... by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by ...

  12. The Impact of Baseline Serum Creatinine on Complete Remission Rate and Long-Term Outcome in Patients with Severe Lupus Nephritis

    Directory of Open Access Journals (Sweden)

    Stephen M. Korbet

    2016-08-01

    Full Text Available Background/Aim: We assess the impact of serum creatinine at baseline on complete remission rate and long-term outcome in severe lupus nephritis (SLN. Methods: A total of 86 adult patients with SLN [International Society of Nephrology/Renal Pathology Society (ISN/RPS class IV lesions] were evaluated based on baseline serum creatinine levels (≤1.0, 1.01-1.5, 1.51-2.0, 2.01-3.0, and >3.0 mg/dl; n = 22, 23, 16, 12, and 13, respectively. The complete remission rates (serum creatinine level of ≤1.4 mg/dl and proteinuria of ≤0.33 g/day and long-term outcomes (stable renal function, dialysis, and death were compared. The patients were followed for 121 ± 64 months. Results: The baseline clinical features were similar, but the chronicity index was significantly higher with increasing levels of serum creatinine. Complete remission rates were significantly higher in patients with lower levels of serum creatinine (86 vs. 52 vs. 19 vs. 25 vs. 0%, p 16 times as likely (OR 16.2; 95% CI: 4.2-61.5 to attain a complete remission and >6 times as likely (OR 6.1; 95% CI: 1.9-18.6 to have stable renal function at the last follow-up as compared to patients with a serum creatinine level of >1.0 mg/dl. The 15-year renal survival rate was greatest among those patients with a baseline serum creatinine level of ≤1.0 mg/dl (76 vs. 57 vs. 48 vs. 25 vs. 10%, p Conclusion: The prognosis of SLN is significantly affected by the serum creatinine level at baseline. The complete remission rate is highest, and the long-term prognosis most favorable, in patients with a baseline serum creatinine level of ≤1.0 mg/dl. This emphasizes the importance of early diagnosis and treatment.

  13. Continuation-Phase Cognitive Therapy's Effects on Remission and Recovery from Depression

    Science.gov (United States)

    Vittengl, Jeffrey R.; Clark, Lee Anna; Jarrett, Robin B.

    2009-01-01

    The authors tested the effects of continuation-phase cognitive therapy (C-CT) on remission and recovery from recurrent major depressive disorder, defined as 6 weeks and 8 months, respectively, of continuously absent or minimal symptoms. Responders to acute-phase cognitive therapy were randomized to 8 months of C-CT (n = 41) or assessment control…

  14. Thalidomide and thalidomide analogues for maintenance of remission in Crohn's disease

    NARCIS (Netherlands)

    A.K. Akobeng; P.C. Stokkers

    2009-01-01

    Background Maintenance of remission is a major issue in the management of Crohn's disease. Thalidomide, a tumour necrosis factor-alpha (TNF-alpha) inhibitor and its analogue, lenalidomide, may have a role in the management of Crohn's disease, but it is not clear whether it is an effective maintenanc

  15. Cases of Psychiatric Morbidity in Pediatric Patients After Remission of Cushing Syndrome.

    Science.gov (United States)

    Keil, Margaret F; Zametkin, Alan; Ryder, Celia; Lodish, Maya; Stratakis, Constantine A

    2016-04-01

    Endogenous Cushing syndrome (CS) may have different effects in children than what has been described in adults. Previous studies of children and adolescents with CS have identified cognitive decline despite reversal of brain atrophy after remission of CS. Although the observations of parents of children and adolescents with CS support personality changes, significant psychopathology has not been described in the literature. We report 9 children who underwent successful surgery (transsphenoidal surgery [TSS] or resection of bronchial carcinoid) for treatment of CS and subsequently developed significant affective pathology. Affective symptoms included anger-rage outbursts, suicidal ideation, irritability, anxiety, and depression. One child, who committed suicide 60 months after TSS, had recently discontinued antidepressant medication. She had a history of anxiety during active CS and was treated with an anxiolytic. The 7 patients with onset of symptoms within 7 months of TSS were on glucocorticoid replacement, and 1-year follow-up evaluation showed recovery of hypothalamic-pituitary-adrenal axis and biochemical evidence of remission. The 2 patients who presented with onset of symptoms at 48 months or later underwent endocrine evaluation that showed biochemical evidence of remission and normal anterior pituitary hormone levels. This is the first report of affective symptoms and behavioral dysregulation, including suicidal ideation, in a subgroup of children and adolescents after remission of CS. Health care providers caring for children with CS who have been cured should continue to screen for mental illness, monitor for changes in behavior, and refer as appropriate to mental health professionals.

  16. Predictors of impaired work functioning in employees with major depression in remission

    NARCIS (Netherlands)

    Vries, G. de; Koeter, M.W.; Nieuwenhuijsen, K.; Hees, H.L.; Schene, A.H.

    2015-01-01

    OBJECTIVES: This study aims to (i) assess work functioning in employees returning to work with a major depression in remission, (ii) study the predictors of impaired work functioning. METHODS: Participants diagnosed with major depressive disorder (MDD), on long term sick leave (mean 27 weeks) and

  17. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5...

  18. Female Overweight and Obesity in Adolescence: Developmental Trends and Ethnic Differences in Prevalence, Incidence, and Remission

    Science.gov (United States)

    Huh, David; Stice, Eric; Shaw, Heather; Boutelle, Kerri

    2012-01-01

    Despite substantial increases in the prevalence of adolescent overweight and obesity documented in recent decades, few studies have prospectively tracked their development during the entire adolescent period. The aims of this study were to characterize developmental trends in prevalence, incidence, and remission of overweight and obesity using…

  19. Dose-remission of pulsating electromagnetic fields as augmentation in therapy-resistant depression

    DEFF Research Database (Denmark)

    Straasø, Birgit; Lauritzen, Lise; Lunde, Marianne

    2014-01-01

    OBJECTIVE: To evaluate to what extent a twice daily dose of Transcranial Pulsating ElectroMagnetic Fields (T-PEMF) was superior to once daily in patients with treatment-resistant depression as to obtaining symptom remission after 8 weeks of augmentation therapy. METHODS: A self-treatment set...

  20. Komplet remission af højmalignt lymfom i ventriklen efter eradikation af Helicobacter pylori

    DEFF Research Database (Denmark)

    Høeg, Rasmus Tetens; Skau, Anne-Marie; Nørgaard, Peter

    2011-01-01

    A 91 year-old man was found to have diffuse large cell B-cell lymphoma (DLBCL), localized to the stomach. Because of his age, his only treatment was anti-Helicobacter pylori therapy. He achieved a complete remission, and six months after the initial presentation, there were no signs of recurrence...

  1. Predictors of impaired work functioning in employees with major depression in remission

    NARCIS (Netherlands)

    Vries, G. de; Koeter, M.W.; Nieuwenhuijsen, K.; Hees, H.L.; Schene, A.H.

    2015-01-01

    OBJECTIVES: This study aims to (i) assess work functioning in employees returning to work with a major depression in remission, (ii) study the predictors of impaired work functioning. METHODS: Participants diagnosed with major depressive disorder (MDD), on long term sick leave (mean 27 weeks) and tr

  2. 19 CFR 351.519 - Remission or drawback of import charges upon export.

    Science.gov (United States)

    2010-04-01

    ... back exceeds the amount of the import charges levied initially on the imported inputs for which... back and the amount paid on imported inputs consumed in production for which remission or drawback was... deferral as a government-provided loan in the amount of the import charges deferred on the inputs...

  3. Continuation-Phase Cognitive Therapy's Effects on Remission and Recovery from Depression

    Science.gov (United States)

    Vittengl, Jeffrey R.; Clark, Lee Anna; Jarrett, Robin B.

    2009-01-01

    The authors tested the effects of continuation-phase cognitive therapy (C-CT) on remission and recovery from recurrent major depressive disorder, defined as 6 weeks and 8 months, respectively, of continuously absent or minimal symptoms. Responders to acute-phase cognitive therapy were randomized to 8 months of C-CT (n = 41) or assessment control…

  4. Long-term remission of CIDP after pulsed dexamethasone or short-term prednisolone treatment

    NARCIS (Netherlands)

    Eftimov, F.; Vermeulen, M.; Doorn, P.A. van; Brusse, E.; Schaik, I.N. van; Berg, L.H. van den; Pol, W.L. van der; Faber, C.G.; Oostrom, J.C. van; Vogels, O.J.; Kleine, B.U.; Norden, A.G.W. van; Verschuuren, J.J.; Hadden, R.D.

    2012-01-01

    OBJECTIVE: Achieving long-term remission after a limited more intense treatment period would prevent prolonged use of corticosteroids or IV immunoglobulin (IVIg) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). In this prospective cohort study we present long-term follow-up data

  5. Widespread reductions of white matter integrity in patients with long-term remission of Cushing's disease

    Directory of Open Access Journals (Sweden)

    Steven J.A. van der Werff

    2014-01-01

    Conclusion: Patients with a history of endogenous hypercortisolism in present remission show widespread changes of white matter integrity in the brain, with abnormalities in the integrity of the uncinate fasciculus being related to the severity of depressive symptoms, suggesting persistent structural effects of hypercortisolism.

  6. Airways responsiveness and development and remission of chronic respiratory symptoms in adults

    NARCIS (Netherlands)

    Xu, XP; Rijcken, B; Schouten, JP; Weiss, ST

    1997-01-01

    Background Many patients with chronic obstructive lung disease show increased airways responsiveness to histamine. We investigated the hypothesis that increased airways responsiveness predicts the development and remission of chronic respiratory symptoms. Methods We used data from 24-year follow-up

  7. Remission of type 2 diabetes mellitus after bariatric surgery - comparison between procedures.

    Science.gov (United States)

    Fernández-Soto, María L; Martín-Leyva, Ana; González-Jiménez, Amalia; García-Rubio, Jesús; Cózar-Ibáñez, Antonio; Zamora-Camacho, Francisco J; Leyva-Martínez, María S; Jiménez-Ríos, Jose A; Escobar-Jiménez, Fernándo

    2017-01-01

    We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy). This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission. Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention. The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18-25).

  8. Remission of nephrotic-range albuminuria in type 1 diabetic patients

    DEFF Research Database (Denmark)

    Hovind, P; Rossing, P; Tarnow, L

    2001-01-01

    OBJECTIVE: To evaluate the cumulative incidence of nephrotic-range albuminuria (NRA), the frequency of remission, and the impact on progression, we analyzed data from a prospective cohort study of type 1 diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: All of the albuminu...

  9. 27 CFR 40.287 - Remission of tax liability on shortage.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Remission of tax liability on shortage. 40.287 Section 40.287 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED...

  10. Female Overweight and Obesity in Adolescence: Developmental Trends and Ethnic Differences in Prevalence, Incidence, and Remission

    Science.gov (United States)

    Huh, David; Stice, Eric; Shaw, Heather; Boutelle, Kerri

    2012-01-01

    Despite substantial increases in the prevalence of adolescent overweight and obesity documented in recent decades, few studies have prospectively tracked their development during the entire adolescent period. The aims of this study were to characterize developmental trends in prevalence, incidence, and remission of overweight and obesity using…

  11. Remission of Maternal Depression: Relations to Family Functioning and Youth Internalizing and Externalizing Symptoms

    Science.gov (United States)

    Foster, Cynthia Ewell; Webster, Melissa C.; Weissman, Myrna M.; Pilowsky, Daniel J.; Wickramaratne, Priya J.; Talati, Ardesheer; Rush, A. John; Hughes, Carroll W.; Garber, Judy; Malloy, Erin; Cerda, Gabrielle; Kornstein, Susan G.; Alpert, Jonathan E.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Fava, Maurizio; King, Cheryl A.

    2008-01-01

    Family functioning and parenting were hypothesized to mediate the relation between remission of maternal depression and children's psychosocial adjustment. Participants were 114 mother-child dyads participating in the Sequenced Treatment Alternatives to Relieve Depression Child 3-month follow-up. All mothers had been diagnosed with major…

  12. Ecotoxicology: Lead

    Science.gov (United States)

    Scheuhammer, A.M.; Beyer, W.N.; Schmitt, C.J.; Jorgensen, Sven Erik; Fath, Brian D.

    2008-01-01

    Lead (Pb) is a naturally occurring metallic element; trace concentrations are found in all environmental media and in all living things. However, certain human activities, especially base metal mining and smelting; combustion of leaded gasoline; the use of Pb in hunting, target shooting, and recreational angling; the use of Pb-based paints; and the uncontrolled disposal of Pb-containing products such as old vehicle batteries and electronic devices have resulted in increased environmental levels of Pb, and have created risks for Pb exposure and toxicity in invertebrates, fish, and wildlife in some ecosystems.

  13. High pathologic complete remission rate from induction docetaxel, platinum and fluorouracil (DCF) combination chemotherapy for locally advanced esophageal and junctional cancer.

    Science.gov (United States)

    Noronha, Vanita; Joshi, Amit; Jandyal, Sunny; Jambhekar, Nirmala; Prabhash, Kumar

    2014-09-01

    Adding docetaxel to the cisplatin/5-fluorouracil induction regimen for locally advanced esophageal and GEJ cancer may increase the pathologic complete remission (pCR) rate, leading to an improved outcome. Institutional ethics committee approved the protocol of retrospective analysis of patients with locally advanced esophageal and GEJ carcinoma, who received 2-3 cycles of docetaxel, cisplatin and 5-fluorouracil (DCF) induction chemotherapy with primary growth factors and prophylactic antibiotics. Following chemotherapy, a restaging scan was performed. If disease was deemed resectable, surgery was performed. Between February 2010 and October 2013, 31 patients received induction DCF. Ninety-four percent patients had squamous histology. Response rate was 81 %: complete remission (CR)-23 % and partial remission-58 %. Eighty-seven percent patients underwent surgery; R0 resection rate was 67 %. pCR occurred in 26 %. Common grade 3/4 toxicities included anemia-23 %, neutropenia-42 %, febrile neutropenia-39 %, diarrhea-39 %, hyponatremia-55 % and hypokalemia-39 %. There were no toxic deaths. At a median follow-up of 34 months (95 % CI 31.3-36.6), estimated median progression-free survival (PFS) was 27 months (95 % CI 11-39) and the overall survival (OS) at 1 year, 2 years and 3 years was 80, 68 and 55 %, respectively. Patients who attained pCR had a significant longer PFS and OS; median PFS and OS were not reached in patients with pCR and were 15 months (95 %CI 8.4-21.5 months), P = 0.012 and 25 months (95 %CI 10.3-39.7), P = 0.023, respectively, in patients who did not attain a pCR. DCF induction chemotherapy leads to pCR of 26 %, which rivals that obtained from chemoradiotherapy. Toxicity is substantial but manageable with adequate supportive care.

  14. IL-12, IL-6 and IFN-γ production by lymphocytes of pregnant women with rheumatoid arthritis remission during pregnancy

    Directory of Open Access Journals (Sweden)

    Henryk Tchórzewski

    2000-01-01

    Full Text Available Background: Rheumatoid arthritis (RA is an autoimmune disease with progressive activity. The RA remission was observed in women during pregnancy, but the mechanism responsible for remission is hypothetical only and concerns mechanisms of immune regulation such as lymphocyte subpopulations and interleukin production.

  15. The influence of design and definition on the proportion of general epilepsy cohorts with remission and intractability.

    Science.gov (United States)

    Abimbola, Seye; Martiniuk, Alexandra L C; Hackett, Maree L; Anderson, Craig S

    2011-01-01

    Remission while on anti-epileptic drug (AED) therapy and remission off AED are the only prognostic criteria defined by the International League against Epilepsy (ILAE), defining remission as 5 seizure-free years. Prognosis studies in epilepsy have investigated other prognostic categories using different designs and definitions. This systematic review explores factors that explain discrepancies in the proportion of patients reported with commonly studied prognostic categories in general epilepsy cohorts. Thirty publications (reporting 37 studies) were included. The outcome categories were classified as immediate remission (5 studies), remission off medication (7 studies), remission on or off medication (15 studies), intractability (9 studies) and no remission after relapse (1 study). The findings show the importance of qualifying estimates specifically by how they were defined in each study, study design, setting and patient population as these have implications for patient management and counselling. The ILAE should define the outcome measures and terminology to which researchers should be required to adhere in subsequent updates of their guidelines on research related to remission and intractability.

  16. Recurrence of Susac Syndrome following 23 Years of Remission

    Directory of Open Access Journals (Sweden)

    Amalia Feresiadou

    2014-05-01

    Full Text Available Susac syndrome is an autoimmune microangiopathy affecting the brain, retina and inner ear (cochlea and semicircular canals, leading to encephalopathy, branch retinal artery occlusions (BRAOs and asymmetric neurosensory hearing loss, respectively. The natural history and long-term prognosis are variable as the disease has been shown to be monophasic and self-limiting, polycyclic or chronic continuous. We describe a 35-year-old woman who presented with a sudden hearing loss in the left ear in the 37th week of her second pregnancy. She subsequently developed BRAO in the right eye 2.5 months after having given birth. MRI findings included round lesions in the corpus callosum which are pathognomonic for Susac syndrome. Previous patient records documented encephalopathy, sudden deafness of the right ear and visual field defects in the left eye at the age of 12, followed by permanent hearing and visual defects. We expand on the variability in the course of Susac syndrome as recurrence may occur after as long as 23 years. Cases of monophasic self-limiting Susac syndrome may in fact turn polycyclic with an interval of more than 2 decades between the bouts of the disease. In these cases, suspecting the development of exacerbation early is important in order to start the treatment promptly.

  17. Leading men

    DEFF Research Database (Denmark)

    Bekker-Nielsen, Tønnes

    2016-01-01

    Through a systematic comparison of c. 50 careers leading to the koinarchate or high priesthood of Asia, Bithynia, Galatia, Lycia, Macedonia and coastal Pontus, as described in funeral or honorary inscriptions of individual koinarchs, it is possible to identify common denominators but also...

  18. Lead grids

    CERN Multimedia

    1974-01-01

    One of the 150 lead grids used in the multiwire proportional chamber g-ray detector. The 0.75 mm diameter holes are spaced 1 mm centre to centre. The grids were made by chemical cutting techniques in the Godet Workshop of the SB Physics.

  19. Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: a two-year follow-up Remissão completa e recaídas dos sintomas obsessivo-compulsivos depois da terapia cognitivo-comportamental em grupo: dois anos de acompanhamento

    Directory of Open Access Journals (Sweden)

    Daniela Tusi Braga

    2010-06-01

    Full Text Available OBJECTIVE: The aim of this study was to assess whether the results obtained with 12 sessions of cognitive-behavioral group therapy with obsessive-compulsive patients were maintained after two years, and whether the degree of symptom remission was associated with relapse. METHOD: Forty-two patients were followed. The severity of symptoms was measured at the end of cognitive-behavioral group therapy and at 18 and 24 months of follow-up. The assessment scales used were the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression, Beck Depression Inventory, and Beck Anxiety Inventory. RESULTS: The reduction in symptom severity observed at the end of treatment was maintained during the two-year follow-up period (F = 57.881; p OBJETIVO: Avaliar se os resultados obtidos com 12 sessões de terapia cognitivo-comportamental em grupo para pacientes com transtorno obsessivo-compulsivo foram mantidos depois de dois anos do final do tratamento e se o grau de remissão dos sintomas esteve associado às recaídas. MÉTODO: Quarenta e dois pacientes foram acompanhados. A gravidade dos sintomas foi avaliada no final da terapia cognitivo-comportamental em grupo, 18 e 24 meses após o término do tratamento. As escalas utilizadas para avaliação foram Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression, Beck Depression Inventory e Beck Anxiety Inventory. RESULTADOS: A redução da gravidade dos sintomas observada no final do tratamento foi mantida durante o período de dois anos de acompanhamento (F = 57,881; p < 0,001. Ao final do tratamento, 9 (21,4% pacientes apresentaram remissão completa, 22 (52,4% remissão parcial e 11 (26,2% não apresentaram mudança na Yale-Brown Obsessive-Compulsive Scale. Dois anos depois, 13 pacientes (31,0% apresentaram remissão completa dos sintomas, 20 (47,6% apresentaram remissão parcial, e 9 (21,4% não apresentaram mudança na Yale-Brown Obsessive-Compulsive Scale. A remissão completa dos sintomas ao

  20. Structural robustness of the gut mucosal microbiota is associated with Crohn's disease remission after surgery.

    Science.gov (United States)

    Mondot, S; Lepage, P; Seksik, P; Allez, M; Tréton, X; Bouhnik, Y; Colombel, J F; Leclerc, M; Pochart, P; Doré, J; Marteau, P

    2016-06-01

    Preventing postoperative recurrence after ileocolonic resection (ICR) for Crohn's disease (CD) is challenging. Defining the disturbances of the microbial composition and community structure after ICR and their link with early disease recurrence is crucial. Microbiota composition (fingerprinting and 16S rDNA sequencing) and community structure (correlation networks of bacterial species) were assessed from ileal mucosa sampled in 20 patients undergoing ICR and 6 months later during endoscopy from above (neoterminal ileum) and below (subanastomotic colon) the surgical anastomosis. ICR had a dramatic effect on gut microbial ecosystem. At surgery, CD mucosa harboured a dysbiotic microbiota with high proportions of α/β Proteobacteria and Bacilli. Six months later, half of the patients had recurrent lesions at ileocolonoscopy and presented higher numbers of Lachnospiraceae. Recurrence of endoscopic lesions was associated with enrichment in Enterococcus durans while patients in remission had increased proportions of Dorea longicatena and Bacteroides plebeius. Structural differences were striking between recurrence and remission microbiota; while the microbiota of patients with CD recurrence exhibited a loose community structure, the microbiota of patients in remission displayed communities that were robustly correlated to each other. Microbiota colonising the neoterminal ileum and subanastomotic colon 6 months after ICR only differed in patients with recurrence. ICR modifies the gut microbiome. Remission after 6 months was associated with homogenous bacterial distribution around the anastomosis. Community structure and bacterial networks highlight target species, including Faecalibacterium prausnitzii and Ruminococcus gnavus, which may allow precise modulations of the overall microbial ecosystem towards remission pattern. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Remission in major depression: results from a geriatric primary care population.

    Science.gov (United States)

    Azar, Armin R; Chopra, Mohit P; Cho, Lydia Y; Coakley, Eugenie; Rudolph, James L

    2011-01-01

    While a recent task force report recommended that remission from major depression be defined according to DSM criteria, most previous work has used depressive symptom rating scales. The current study sought to identify baseline factors associated with treatment outcome in major depression, diagnosed according to DSM-IV criteria. Data from the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study were utilized. This analysis focused on 792 geriatric primary care patients with major depression at baseline, which was randomized to services by a mental health professional in primary care or specialty settings. Major depression was diagnosed according to DSM-IV criteria based on a structured interview at baseline and 6 months. The primary outcome was the absence of any DSM-IV depressive disorder at six-month follow-up. Association with baseline demographic characteristics, comorbid anxiety disorder, 'at risk' drinking, number of co-occurring medical conditions, and depressive symptom severity was examined using multiple logistic regression modeling. Remission occurred in 228 (29%) patients with completed follow-up assessments, while 564 (71%) did not remit. Factors which increased the odds of non-remission included comorbid anxiety (OR=1.60, 95% CI 1.11-2.31), female sex (OR=1.49, 95% CI 1.04-2.15), general medical comorbidity (OR=1.15, 95% CI 1.07-1.24), and increased baseline depressive symptom severity (OR=1.04, 95% CI 1.03-1.06). The findings underscore the importance of using DSM criteria to define remission from major depression, and suggest that concurrent measurement of depression severity, comorbid anxiety, and medical comorbidity are important in identifying patients requiring targeted interventions to optimize remission from major depression. Copyright © 2010 John Wiley & Sons, Ltd.

  2. Narrow-band imaging with magnifying endoscopy for Peyer's patches is useful in predicting the recurrence of remissive patients with ulcerative colitis

    Science.gov (United States)

    Hiyama, Satoshi; Kawai, Syoichiro; Mukai, Akira; Shiraishi, Eri; Iwatani, Shuko; Yamaguchi, Toshio; Araki, Manabu; Hayashi, Yoshito; Shinzaki, Shinichiro; Mizushima, Tsunekazu; Tsujii, Masahiko; Takehara, Tetsuo

    2016-01-01

    Background/Aims Peyer's patches (PPs) are aggregates of lymphoid follicles that are mainly located in the distal ileum; they play a major role in mucosal immunity. We recently reported that patients with ulcerative colitis (UC) have alterations in PPs that can be detected using narrow-band imaging with magnifying endoscopy (NBI-ME). However, the usefulness of NBI-ME in UC treatment as a whole is still unknown. Methods We collected NBI-ME images of PPs from 67 UC patients who had undergone ileocolonoscopy. We evaluated changes in the villi using the "villi index," which is based on three categories: irregular formation, hyperemia, and altered vascular network pattern. The patients were divided into two groups on the basis of villi index: low (L)- and high (H)-types. We then determined the correlation between morphological alteration of the PPs and various clinical characteristics. In 52 patients who were in clinical remission, we also analyzed the correlation between NBI-ME findings of PPs and clinical recurrence. Results The time to clinical recurrence was significantly shorter in remissive UC patients with H-type PPs than in those with L-type PPs (P<0.01). Moreover, PP alterations were not correlated with age, sex, disease duration, clinical activity, endoscopic score, or extent of disease involvement. Multivariate analysis revealed that the existence of H-type PPs was an independent risk factor for clinical recurrence (hazard ratio, 3.3; P<0.01). Conclusions UC patients with morphological alterations in PPs were at high risk of clinical relapse. Therefore, to predict the clinical course of UC, it may be useful to evaluate NBI-ME images of PPs. PMID:27799882

  3. Nutritional follow-up of patients with ulcerative colitis during periods of intestinal inflammatory activity and remission

    Directory of Open Access Journals (Sweden)

    Juliana Ripoli

    2010-03-01

    Full Text Available CONTEXT: Ulcerative colitis is an inflammatory bowel disease involving superficial inflammation of the mucosa of the colon, rectum, and anus, sometimes including the terminal ileum. When in clinical activity, the disease is characterized by various daily evacuations containing blood, mucus and/or pus alternating periods of remission. OBJECTIVE: To compare nutritional parameters (dietary, biochemical and anthropometric among patients with ulcerative colitis followed up on an outpatient basis over a period of 1 year and during periods of intestinal inflammatory activity and remission. METHODS: Sixty-five patients were studied over a period of 1 year and divided into two groups: group 1 with inflammatory disease activity (n = 24, and group 2 without disease activity (n = 41. Anthropometric measures, biochemical parameters, quantitative food intake, and qualitative food frequency were analyzed. RESULTS: A significant reduction in body mass index and weight and in the intake of energy, proteins, lipids, calcium, iron and phosphorus was observed in the group with inflammatory activity (group 1 when compared to the period of clinical remission. The most affected food groups were cereals, legumes, oils, and fats. In contrast, in group 2 significant differences in triceps and sub scapular skin fold thickness, total protein, hemoglobin and hematocrit were observed between the first and final visit. Calcium and vitamin B6 intake, as well as the consumption of legumes, meat and eggs, and sugar and sweets, was significantly higher than on the first visit. CONCLUSION: Patients with ulcerative colitis followed up on an outpatient basis tend to be well nourished. However, the nutritional aspects studied tend to worsen during the period of inflammatory disease activity.CONTEXTO: A retocolite ulcerativa inespecífica compreende uma das doenças inflamatórias intestinais, com características de inflamação superficial da mucosa do cólon, reto, ânus, podendo

  4. Impacto psicológico de la enfermedad de Crohn en pacientes en remisión: riesgo de ansiedad y depresión Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks

    Directory of Open Access Journals (Sweden)

    M. Iglesias

    2009-04-01

    Full Text Available Introducción: el papel de la ansiedad y depresión en pacientes con enfermedad de Crohn (EC en remisión es incierto. Objetivo: evaluar la frecuencia de ansiedad y depresión en pacientes con EC en remisión y potenciales factores que pueden influir en el desarrollo de esos síntomas. Métodos: se incluyeron pacientes con EC mayores de 18 años, que estuviesen en remisión durante al menos 6 meses. La remisión se definió como un CDAI Background: the role of anxiety and depression in CD patients in remission has been poorly investigated. Objective: the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms. Methods: CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn's disease Activity Index (CDAI < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression. Results: 92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years. One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39% and 22 (24% patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05. In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05. Conclusions: despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive

  5. [Social functioning and quality of life in schizophrenia patients --relationship with symptomatic remission and duration of illness].

    Science.gov (United States)

    Górna, Krystyna; Jaracz, Krystyna; Jaracz, Jan; Kiejda, Justyna; Grabowska-Fudala, Barbara; Rybakowski, Janusz

    2014-01-01

    The assessment of social functioning and subjective quality of life in relation to symptomatic remission in schizophrenia patients after a first psychiatric hospitalization, as well as the analysis of connection between intensity of psychopathological symptoms and the level of functioning and quality of life, taking into account the status of remission and duration of illness. Sixty-four patients were assessed, at 13 months (1st examination) and at mean 8 years (2nd examination) after the first hospitalization, and compared with two control groups of healthy persons. The following scales were used: Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), WHO Quality of Life (WHOQoL--Bref) scale and Global Assessment Scale (GAS). At first examination, the score of SFS domains was not significantly different between patients in remission and without remission while the score of most domains of WHOQoL was significantly higher in patients with remission. At second examination, the scores of both SFS and WHOQoL were significantly higher in patients with remission and did not differ significantly from healthy persons. In both examinations, significant correlations between PANSS and SFS and WHOQoL scores were found, especially in patients without remission. At mean 8 years after first psychiatric hospitalization, 2/3 of the patients with schizophrenia did not get a symptomatic remission and had worse social functioning and quality of life compared to patients with remission and to healthy controls. Psychopathological symptoms correlated significantly with social functioning and quality of life, especially among patients without remission.

  6. Remission in rheumatoid arthritis: a comparison of the 2 newly proposed ACR/EULAR remission criteria with the rheumatoid arthritis disease activity index-5, a patient self-report disease activity index.

    Science.gov (United States)

    Rintelen, Bernhard; Sautner, Judith; Haindl, Pia; Mai, Harsono; Brezinschek, Hans-Peter; Leeb, Burkhard F

    2013-04-01

    We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission. The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level. In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions. Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean

  7. Who Leads China's Leading Universities?

    Science.gov (United States)

    Huang, Futao

    2017-01-01

    This study attempts to identify the major characteristics of two different groups of institutional leaders in China's leading universities. The study begins with a review of relevant literature and theory. Then, there is a brief introduction to the selection of party secretaries, deputy secretaries, presidents and vice presidents in leading…

  8. Predictors of remission in the treatment of major depressive disorder: real-world evidence from a 6-month prospective observational study

    Directory of Open Access Journals (Sweden)

    Novick D

    2015-01-01

    Full Text Available Diego Novick,1 Jihyung Hong,1 William Montgomery,2 Héctor Dueñas,3 Magdy Gado,4 Josep Maria Haro5 1Eli Lilly and Company, Windlesham, UK; 2Eli Lilly Australia Pty Ltd, West Ryde, Australia; 3Eli Lilly de Mexico, Mexico City, Mexico; 4Eli Lilly and Company, Riyadh, Saudi Arabia; 5Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain Background: This study examined potential predictors of remission among patients treated for major depressive disorder (MDD in a naturalistic clinical setting, mostly in the Middle East, East Asia, and Mexico. Methods: Data for this post hoc analysis were taken from a 6-month prospective, noninterventional, observational study that involved 1,549 MDD patients without sexual dysfunction at baseline in 12 countries worldwide. Depression severity was measured using the Clinical Global Impression of Severity and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16. Depression-related pain was measured using the pain-related items of the Somatic Symptom Inventory. Remission was defined as a QIDS-SR16 score ≤5. Generalized estimating equation regression models were used to examine baseline factors associated with remission during follow-up. Results: Being from East Asia (odds ratio [OR] 0.48 versus Mexico; P<0.001, a higher level of depression severity at baseline (OR 0.77, P=0.003, for Clinical Global Impression of Severity; OR 0.92, P<0.001, for QIDS-SR16, more previous MDD episodes (OR 0.92, P=0.007, previous treatments/therapies for depression (OR 0.78, P=0.030, and having any significant psychiatric and medical comorbidity at baseline (OR 0.60, P<0.001 were negatively associated with remission, whereas being male (OR 1.29, P=0.026 and treatment with duloxetine (OR 2.38 versus selective serotonin reuptake inhibitors, P<0.001 were positively associated with remission. However, the association between Somatic Symptom Inventory pain scores

  9. Consenso em reumatologia pediátrica: parte I - definição dos critérios de doença inativa e remissão em artrite idiopática juvenil/artrite reumatóide juvenil Consensus in pediatric rheumatology: part I - criteria definition of inactive disease and remission in juvenile idiopathic arthritis / juvenile rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Claudia Machado

    2005-02-01

    Full Text Available Não há critérios universalmente aceitos para a remissão clínica em artrite idiopática juvenil/artrite reumatóide juvenil (AIJ/ARJ. OBJETIVO: formar consenso sobre estes critérios. MÉTODOS: foi utilizado um inquérito pelo método Delphi para reunir os critérios vigentes e utilizados por especialistas em reumatologia pediátrica (RP no mundo todo. A análise dos resultados constituiu a base para uma Consensus Conference utilizando a nominal group technique (NGT para alcançar o consenso nas questões não resolvidas após a análise dos questionários deste inquérito. Cento e trinta RP de 34 países responderam ao inquérito e 20 RP de nove países elegeram os critérios durante dois dias, em processo de discussão estruturada, para formar consenso pela NGT. RESULTADOS: os critérios de doença inativa deveriam incluir: 1 nenhuma articulação com artrite em atividade; 2 ausência de febre, rash, serosite, esplenomegalia ou linfadenopatia generalizada atribuída à AIJ/ARJ; 3 ausência de uveíte em atividade; 4 VHS ou PCR negativas (se ambos forem testados, ambos devem ser normais; 5 a avaliação global pelo médico deve indicar o melhor escore possível, indicando doença inativa. CONCLUSÕES: de acordo com o voto de consenso, seis meses contínuos de doença inativa são necessários para se considerar um paciente em estado de remissão com medicação; 12 meses contínuos de doença inativa e sem medicação são necessários para considerar um paciente em estado de remissão sem medicação. O critério para remissão sem medicação deve prever com acurácia de 95% a probabilidade inferior a 20% de recaída em cinco anos.Validated and widely accepted criteria for clinical remission in JIA/JRA do not currently exist. OBJECTIVE: To achieve consensus in this matter. METHODS: The Delphi consensus-formation approach was used to gather the criteria in use by pediatric rheumatologists (PR worldwide. Results from the questionnaires

  10. Toward an online cognitive and emotional battery to predict treatment remission in depression

    Directory of Open Access Journals (Sweden)

    Gordon E

    2015-02-01

    Full Text Available Evian Gordon,1 A John Rush,2 Donna M Palmer,3,4 Taylor A Braund,3 William Rekshan1 1Brain Resource, San Francisco, CA, USA; 2Duke-NUS, Singapore; 3Brain Resource, Sydney, NSW, Australia; 4Brain Dynamics Center, Sydney Medical School – Westmead and Westmead Millennium Institute, The University of Sydney, Sydney, NSW, Australia Purpose: To evaluate the performance of a cognitive and emotional test battery in a representative sample of depressed outpatients to inform likelihood of remission over 8 weeks of treatment with each of three common antidepressant medications. Patients and methods: Outpatients 18–65 years old with nonpsychotic major depressive disorder (17 sites were randomized to escitalopram, sertraline or venlafaxine-XR (extended release. Participants scored ≥12 on the baseline 16-item Quick Inventory of Depressive Symptomatology – Self-Report and completed 8 weeks of treatment. The baseline test battery measured cognitive and emotional status. Exploratory multivariate logistic regression models predicting remission (16-item Quick Inventory of Depressive Symptomatology – Self-Report score ≤5 at 8 weeks were developed independently for each medication in subgroups stratified by age, sex, or cognitive and emotional test performance. The model with the highest cross-validated accuracy determined the participant proportion in each arm for whom remission could be predicted with an accuracy ≥10% above chance. The proportion for whom a prediction could be made with very high certainty (positive predictive value and negative predictive value exceeding 80% was calculated by incrementally increasing test battery thresholds to predict remission/non-remission. Results: The test battery, individually developed for each medication, improved identification of remitting and non-remitting participants by ≥10% beyond chance for 243 of 467 participants. The overall remission rates were escitalopram: 40.8%, sertraline: 30.3%, and

  11. Leading Cities

    DEFF Research Database (Denmark)

    Pogner, Karl-Heinz

    2017-01-01

    and technical engineering; Smart Cities) is very prominent in the traditional mass media discourse, in PR / PA of tech companies and traditional municipal administrations; whereas the second one (participation; Livable Cities) is mostly enacted in social media, (local) initiatives, movements, (virtual......) communities, new forms of urban governance in municipal administration and co-competitive city networks. Both forms seem to struggle for getting voice and power in the discourses, negotiations, struggles, and conflicts in Urban Governance about the question how to manage or lead (in) a city. Talking about...

  12. Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

    Science.gov (United States)

    Lee, Chang Min; Lee, Dong Ho; Ahn, Byung Kyu; Hwang, Jae Jin; Yoon, Hyuk; Park, Young Soo; Shin, Cheol Min; Kim, Nayoung

    2017-01-01

    Background/Aims In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings. Methods In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR. Results The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings. Conclusions In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types. PMID:27009028

  13. Knowledge and insight in relation to functional remission in patients with long-term psychotic disorders

    DEFF Research Database (Denmark)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Hartvig, Per

    2009-01-01

    : To investigate the knowledge and insight in relation to treatment response. METHODS: A naturalistic study was performed using patient interviews and information gathered from patient drug charts. Apart from the rating scales used for classification of treatment response (CANSEPT method), the SPKS knowledge......BACKGROUND: Patients with psychotic symptoms often respond poorly to treatment. Outcomes can be affected by biological, physiological and psychological factors according to the vulnerability-stress model. The patient's coping strategies and beliefs have been correlated with outcomes. OBJECTIVES...... of illness and drugs rating scale was utilized. RESULTS: In the group of patients in functional remission (FR; n = 38), 37% had insight into their illness as compared to 10% among those not in functional remission (non-FR; n = 78; P

  14. Remission of psoriasis and psoriatic arthritis during bevacizumab therapy for renal cell cancer

    Directory of Open Access Journals (Sweden)

    Ananaya Datta-Mitra

    2014-01-01

    Full Text Available Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF, is employed for treatment of several cancers and retinopathies. Although previous reports of remission of psoriasis with bevacizumab do exist, but its current experience for psoriatic arthritis (PsA is still limited. In this report, we describe a patient with metastatic renal cell cancer, psoriasis and PsA, who experienced a complete remission of psoriasis and PsA during bevacizumab therapy without any other management for psoriasis and PsA. We also found a flare up of his psoriatic disease after switching to other kinase inhibitors like sorafenib or sunitinib. This suggests that bevacizumab might have a promising future in the treatment of psoriasis and PsA.

  15. Nocturnal secretion of growth hormone, noradrenaline, cortisol and insulin in cluster headache remission.

    Science.gov (United States)

    Meyer, E L; Marcus, C; Waldenlind, E

    2007-08-01

    We have previously shown decreased, nocturnal lipolysis in both phases of cluster headache (CH). Lipolysis is stimulated by noradrenaline (NA), growth hormone (GH) and cortisol, and inhibited by insulin, hormones which are directly or indirectly regulated by the hypothalamus. Our aim was to investigate the nocturnal secretion of NA, GH, cortisol and insulin in nine CH patients in remission and 10 healthy controls. Nocturnal venous blood samples were collected in hourly intervals for analysis of NA, cortisol and insulin and in 30-min intervals for GH. We found a reduced increase in GH between 24.00 h and 01.00 h (anova, P insulin did not differ significantly between the groups. The altered nocturnal GH pattern that was seen in CH patients in remission might in part explain the altered nocturnal lipolysis previously found and further indicate a permanent hypothalamic disturbance in CH.

  16. Partial remission of acute myeloid leukemia complicating multiple myeloma following COAP chemotherapy: A case report.

    Science.gov (United States)

    Shen, Man; Sun, Wan-Jun; Huang, Zhong-Xia; Zhang, Jia-Jia; An, Na; Li, Xin

    2015-03-01

    A 77-year-old male was admitted to hospital after complaining of fever and a cough for three days. A diagnosis of multiple myeloma was confirmed following M protein identification and a bone marrow biopsy. The patient received chemotherapy regimens of bortezomib plus dexamethasone, cyclophosphamide, thalidomide and dexamethasone, and thalidomide and dexamethasone, and was prescribed thalidomide (100 mg/d) to be taken orally for maintenance therapy. After a further two years the patient was subsequently diagnosed with acute myeloid leukemia. Chemotherapy regimens of cytarabine, aclacinomycin and daunorubicin, homoharringtonine and etoposide, and mitoxantrone and cytarabine resulted in no remission. Partial remission was obtained with a course of ifosfamide, vindesine, cytarabine and prednisone chemotherapy. This therapy may be an alternative treatment for secondary leukemia, particularly in elderly patients.

  17. Remission of type 2 diabetes in a hypogonadal man under long-term testosterone therapy.

    Science.gov (United States)

    Haider, Ahmad; Haider, Karim S; Saad, Farid

    2017-01-01

    In daily practice, clinicians are often confronted with obese type 2 diabetes mellitus (T2DM) patients for whom the treatment plan fails and who show an inadequate glycemic control and/or no sustainable weight loss. Untreated hypogonadism can be the reason for such treatment failure. This case describes the profound impact testosterone therapy can have on a male hypogonadal patient with metabolic syndrome, resulting in a substantial and sustained loss of body weight, pronounced improvement of all critical laboratory values and finally complete remission of diabetes. Hypogonadism occurs frequently in men with T2DM.In case of pronounced abdominal fat deposition and T2DM, the male patient should be evaluated for testosterone deficiency.Untreated hypogonadism can complicate the successful treatment of patients with T2DM.Under testosterone therapy, critical laboratory values are facilitated to return back to normal ranges and even complete remission of diabetes can be achieved.

  18. Body composition and phase angle in Russian children in remission from acute lymphoblastic leukemia

    Science.gov (United States)

    Tseytlin, G. Ja; Khomyakova, I. A.; Nikolaev, D. V.; Konovalova, M. V.; Vashura, A. Yu; Tretyak, A. V.; Godina, E. Z.; Rudnev, S. G.

    2010-04-01

    Elevated degree of body fatness and changes in other body composition parameters are known to be common effects of treatment for acute lymphoblastic leukemia (ALL) in children. In order to study peculiarities of somatic growth and development in ALL survivors, we describe the results of BIA body composition analysis of 112 boys and 108 girls aged 5-18 years in remission from ALL (remission time range 1-13 years) compared to data from the same number of age- and sex-matched healthy controls (n=220). Detrimental effect on height in ALL boys was observed, whereas girls experienced additional weight gain compared to healthy subjects. In ALL patients, resistance, body fat, and percent body fat were significantly increased. The reactance, phase angle, absolute and relative values of skeletal muscle and body cell mass were significantly decreased. Principal component analysis revealed an early prevalence of adiposity traits in the somatic growth and development of ALL girls compared to healthy controls.

  19. Spontaneous remission of pituitary macroadenomas in women:report of two cases

    Institute of Scientific and Technical Information of China (English)

    WU Zhe-bao; SU Zhi-peng; WU Jin-sen

    2007-01-01

    @@ Spontaneous regression of pituitary macroadenomas is rare. It is generally thought that absorption of the necrotic tissue after pituitary apoplexy may cause the spontaneous healing of the tumor. However, such cases are often accompanied by hypopituitarism, which sould be treated with hormone replacement therapy. Here we report two cases of spontaneous remission of pituitary macroadenomas in women, who had complete tumor disappearance with preserved pituitary function.

  20. Cystic fibrosis and Crohn’s disease:Successful treatment and long term remission with infliximab

    Institute of Scientific and Technical Information of China (English)

    Francesca; Vincenzi; Barbara; Bizzarri; Alessia; Ghiselli; Nicola; de; Angelis; Fabiola; Fornaroli; Gian; Luigi; de; Angelis

    2010-01-01

    The association of cystic fibrosis and Crohn's disease (CD) is well known, but to date, there are very few cas-es in the literature of patients suffering from mucovisci-dosis who have required treatment with infliximab. We report the case of a 23-year-old patient suffering from cystic fibrosis and severe CD treated successfully with infliximab without any infective complications or wors-ening of the pulmonary disease and with a long term (2 years) complete remission.

  1. Spontaneous Remission From PTSD Depends on the Number of Traumatic Event Types Experienced

    OpenAIRE

    Kolassa, Iris; Ertl, Verena; Eckart, Cindy; Kolassa, Stephan; Onyut, Lamaro Patience; Elbert, Thomas

    2010-01-01

    As exposure to different types of traumatic stressors increases, the prevalence of PTSD increases. However, little is known about the effects of cumulative exposure to traumatic stress on the maintenance and remission from PTSD. In 2006/2007, we investigated 444 refugees from the 1994 Rwandan genocide, assessing exposure to traumatic events, current and lifetime PTSD, and PTSD symptom severity. Higher trauma exposure was associated with higher prevalence of current and lifetime PTSD, with low...

  2. Intravenous Iron Given prior to Pregnancy for Restless Legs Syndrome is Associated with Remission of Symptoms

    OpenAIRE

    2012-01-01

    Restless legs syndrome (RLS) is more common during pregnancy than in the general population, occurring at a 2-3 times higher prevalence. While iron, genetics, and central nervous system dopamine have been shown to play major roles in RLS unrelated to pregnancy, the etiology and treatment of RLS during pregnancy have not been adequately delineated. We describe a novel approach where a 23-year-old female was given intravenous iron prior to pregnancy, with complete remission of RLS symptoms unti...

  3. Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Levine, Arie; Turner, Dan; Pfeffer Gik, Tamar

    2014-01-01

    ) in a large pediatric prospective multicenter study. METHODS: Patients enrolled at diagnosis into the growth relapse and outcomes with therapy in Crohn's disease study were evaluated for disease activity, CRP, and fecal calprotectin at 8, 12 and 52 weeks after starting treatment. The primary endpoint was week...... at week 12 was impacted by type of induction therapy, but not by early immunomodulation. It was associated with more corticosteroids-free remission at week 52 and a trend for less relapses....

  4. [Bone marrow autotransplantation in patients with acute myeloblastic leukemia in primary remission].

    Science.gov (United States)

    Richard, C; Iriondo, A; Baro, J; Conde, E; Hermosa, V; Alsar, M J; Gómez Casares, M T; Muruzabal, M J; Pérez Encinas, M; Zubizarreta, A

    1990-09-22

    Fifteen bone marrow autotransplants (BMAT) in patients with acute myeloblastic leukemia (AML) were performed after the first remission. The mean age was 37 years (range 12 to 60 years). According to the morphological classification FAB, 8 patients had monocytic leukemia (M4, M5) and 7 myeloid leukemia (M1, M2, M3). The mean interval elapsed between the date of complete remission and the BMAT was 3.9 months (range 1 to 5-9 months). In 8 patients this interval was longer than 6 months and in 7 cases it was shorter than 6 months. After achievement of the complete remission all patients underwent certain cycles of intensification before the BMAT. Eight patients received only a cycle whereas 7 patients received more than one cycle (between 2 and 4). The conditioning protocol consisted of cyclophosphamide (CP) (60 mg/kg x 2) and total body radiotherapy (TBR) (10 Gy) in 9 patients; CP and busulfan in five; and CP, cytarabine at high doses and melphalan in one case. Marrow extraction was performed after completion of chemotherapy of intensification. In 5 cases the bone marrow was depleted of leukemic cells by previous in vitro treatment with ASTA-Z. There are at present 8 alive patients. The survival free of illness was 51.8%. Seven patients died: 3 cases because relapse of the leukemia, 3 due to attachment failure of the transplantation, and one patient suffered a viral myocarditis. The survival free of illness was significantly longer in those patients transplanted after 6 months of the complete remission.

  5. Favourable course of disease after incomplete remission on {sup 131}I therapy in children with pulmonary metastases of papillary thyroid carcinoma: 10 years follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Biko, Johannes; Reiners, Christoph; Kreissl, Michael C.; Verburg, Frederik A. [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Demidchik, Yuri [Thyroid Cancer Centre, Minsk (Belarus); Drozd, Valentina [International Belarussian-German Foundation, Minsk (Belarus)

    2011-04-15

    The aim of this study is to report on a collective of 20 children from Belarus who had developed papillary thyroid carcinoma with pulmonary metastases after the Chernobyl disaster. In all children fractionated radioiodine therapy (RIT) was ceased before achieving complete remission due to a lack of further effects of {sup 131}I therapy and an increased risk of pulmonary fibrosis. The 20 children (12 girls) were treated with {sup 131}I using 50 MBq/kg body weight for thyroid remnant ablation and 100 MBq/kg for further therapy in intervals of 5-12 months. After five to six courses and a cumulative activity of about 24 GBq {sup 131}I no further RIT was conducted; the median thyroglobulin (TG) was 56 {mu}g/l at this time. All patients were followed for at least 10 years after cessation of RIT using diagnostic whole-body scintigraphy, CT of the chest, lung function testing and stimulated TG measurements every 1-3 years. During follow-up after the last RIT a continuous decline of values for TG levels of {proportional_to}35% per year was observed between individual visits. The median Tg level at the time of cessation of {sup 131}I therapy was 56 {mu}g/l; however, at the last visit 16 of 20 patients had a TG level {<=}10 {mu}g/l (median 2.4 {mu}g/l). Neither on diagnostic radioiodine whole-body scan nor on CT was progression of lung metastases observed. No significant pulmonary fibrosis developed. In spite of incomplete remission of thyroid cancer at cessation of RIT, a continuing spontaneous decline of TG and clinically stable partial remissions were observed in this collective of children. Therefore, if RIT does not show further effects, the administration of further courses should be handled restrictively. (orig.)

  6. Nurses' Perceptions and Practices Toward Clinical Alarms in a Transplant Cardiac Intensive Care Unit: Exploring Key Issues Leading to Alarm Fatigue.

    Science.gov (United States)

    Sowan, Azizeh Khaled; Tarriela, Albert Fajardo; Gomez, Tiffany Michelle; Reed, Charles Calhoun; Rapp, Kami Marie

    2015-03-16

    Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses' perceptions and common clinical practices toward clinical alarms, where little information is available. Our aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms and benchmark the results against the 2011 Healthcare Technology Foundation's (HTF) Clinical Alarms Committee Survey. A quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were surveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms survey. Results were compared to the 2011 HTF data. Correlations among variables were examined. All TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms are frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011 HTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are complex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the lack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (Palarms and poor usability of the cardiac monitors. A lack of standardized approaches exists in changing patients' electrodes and individualizing parameters. Around 60% of nurses indicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for training

  7. Enteric microbiota leads to new therapeutic strategies for ulcerative colitis

    OpenAIRE

    Chen, Wei-Xu; Ren, Li-Hua; Shi, Rui-Hua

    2014-01-01

    Ulcerative colitis (UC) is a leading form of inflammatory bowel disease that involves chronic relapsing or progressive inflammation. As a significant proportion of UC patients treated with conventional therapies do not achieve remission, there is a pressing need for the development of more effective therapies. The human gut contains a large, diverse, and dynamic population of microorganisms, collectively referred to as the enteric microbiota. There is a symbiotic relationship between the huma...

  8. Spontaneous remission of post-transplant recurrent focal and segmental glomerulosclerosis

    Directory of Open Access Journals (Sweden)

    Bassam Saeed

    2011-01-01

    Full Text Available A 12-year-old girl with a history of steroid and cyclosporine (CsA resistant nephrotic syndrome owing to focal and segmental glomerulosclerosis (FSGS has progressed to end-stage renal disease (ESRD for which she underwent hemodialysis for 18 months before she successfully received a fully matched kidney transplant from her sister at the age of nine years. The post transplantation (Tx period was marked by an early and massive proteinuria indicating recurrent FSGS for which she received 12 sessions of plasmapheresis (PP; unfortunately, she did not appear to have any response to the PP therapy; thereafter, a conservative management comprising essentially enalapril and losartan has been initiated and was also not successful during the first four months, however, a very gradual response has been noticed to occur after five months of conservative therapy and ultimately, the patient attained complete remission after 21 months of treatment. Amazingly, 15 months after discontinuation of enalapril and losartan, she remained in a complete and sustained remission with a good renal allograft function. To the best of our knowledge, this is the first case ever reported in the literature of a "spontaneous" remission of post transplant recurrent FSGS.

  9. Bariatric surgery-induced weight loss causes remission of food addiction in extreme obesity.

    Science.gov (United States)

    Pepino, Marta Yanina; Stein, Richard I; Eagon, J Christopher; Klein, Samuel

    2014-08-01

    To test the hypotheses that bariatric surgery-induced weight loss: induces remission of food addiction (FA), and normalizes other eating behaviors associated with FA. Forty-four obese subjects (BMI= 48 ± 8 kg/m(2) ) were studied before and after ∼20% weight loss induced by bariatric surgery (25 Roux-en-Y gastric bypass, 11 laparoscopic adjustable gastric banding, and eight sleeve gastrectomy). We assessed: FA (Yale Food Addiction Scale), food cravings (Food Craving Inventory), and restrictive, emotional and external eating behaviors (Dutch Eating Behavior Questionnaire). FA was identified in 32% of subjects before surgery. Compared with non-FA subjects, those with FA craved foods more frequently, and had higher scores for emotional and external eating behaviors (all P-values 0.8). Surgery-induced weight loss resulted in remission of FA in 93% of FA subjects; no new cases of FA developed after surgery. Surgery-induced weight loss decreased food cravings, and emotional and external eating behaviors in both groups (all P-values 1.1). Bariatric surgery-induced weight loss induces remission of FA and improves several eating behaviors that are associated with FA. Copyright © 2014 The Obesity Society.

  10. Remission of invasive, cancer stem-like glioblastoma xenografts using lentiviral vector-mediated suicide gene therapy.

    Directory of Open Access Journals (Sweden)

    Peter C Huszthy

    Full Text Available BACKGROUND: Glioblastoma is the most frequent and most malignant primary brain tumor with a poor prognosis. The translation of therapeutic strategies for glioblastoma from the experimental phase into the clinic has been limited by insufficient animal models, which lack important features of human tumors. Lentiviral gene therapy is an attractive therapeutic option for human glioblastoma, which we validated in a clinically relevant animal model. METHODOLOGY/PRINCIPAL FINDINGS: We used a rodent xenograft model that recapitulates the invasive and angiogenic features of human glioblastoma to analyze the transduction pattern and therapeutic efficacy of lentiviral pseudotyped vectors. Both, lymphocytic choriomeningitis virus glycoprotein (LCMV-GP and vesicular stomatitis virus glycoprotein (VSV-G pseudotyped lentiviral vectors very efficiently transduced human glioblastoma cells in vitro and in vivo. In contrast, pseudotyped gam